Home LiteratureArticle Details
PMID: 7814535 Published · ppublish English Journal Article Meta-Analysis Research Support, Non-U.S. Gov't

Concordance of endotoxemia with gram-negative bacteremia in patients with gram-negative sepsis: a meta-analysis.

Journal of clinical microbiology ·Vol. 32 ·No. 9 ·1994-09-00 ·Pages 2120-7

Hurley JC

Abstract

The Limulus amebocyte lysate (LAL) assay is a sensitive method for detecting endotoxin. Using gram-negative (GN) bacteremia as the basis for comparison, concordance with endotoxemia in 45 studies could be expressed as an odds ratio. Calculation of summary odds ratios by the Mantel-Haenszel-Peto method indicated that the concordance of the results was no higher by the chromogenic LAL assay than by the gelation version, and the sensitivity was improved by only 11% (62 versus 51%). Endotoxemia was detected in 77 (68%) of 114 patients with bacteremia caused by an organism that was not a member of the family Enterobacteriaceae, whereas endotoxemia was detected in only 120 (45%) of 269 patients with bacteremia caused by a member of the family Enterobacteriaceae or an anaerobe (P < 0.001). This difference was also apparent for patients with GN bacteremia for whom a fatal outcome had been recorded. The prevalence of GN bacteremia in the tested population and the type of etiological agent are critical and previously unrecognized variables which affect the interpretation of the LAL test in patients with suspected sepsis.

MeSH Terms
Bacteremia/blood,diagnosis,epidemiology,microbiology Endotoxins/blood Enterobacteriaceae Infections/blood,microbiology Gram-Negative Bacterial Infections/blood,diagnosis,microbiology Humans Limulus Test Odds Ratio Predictive Value of Tests Prevalence Sensitivity and Specificity
Chemicals
Endotoxins
Authors & Affiliations
1 authors, click to expand affiliations / ORCID
Hurley J C
Division of Infectious Diseases, Children's Hospital & Medical Center, Seattle, Washington 98105-0371.
References (73)
73 references, click to expand
  1. Diagnostic and prognostic significance of plasma endotoxin determination in febrile patients with haematological malignancies.
    Eur J Cancer. 1994;30A(2):145-7 PMID: 8155385
  2. An improved chromogenic substrate endotoxin assay for clinical use.
    J Clin Pathol. 1983 Oct;36(10):1145-9 PMID: 6352744
  3. Host metabolites that phenotypically increase the resistance of Haemophilus influenzae type b to clearance mechanisms.
    J Infect Dis. 1991 May;163(5):1073-9 PMID: 2019756
  4. Endotoxin, bile salts and renal function in obstructive jaundice.
    Br J Surg. 1976 Oct;63(10):774-8 PMID: 791436
  5. Endotoxemia in protein-energy malnutrition.
    J Pediatr Gastroenterol Nutr. 1988 Mar-Apr;7(2):225-8 PMID: 3127570
  6. Clinical utility of the Limulus amebocyte lysate (LAL) test.
    Prog Clin Biol Res. 1985;189:307-27 PMID: 4048211
  7. Have you ever meta-analysis you didn't like?
    Ann Intern Med. 1991 Feb 1;114(3):244-6 PMID: 1984750
  8. Clinical experience on the detection of endotoxemia with the limulus test.
    J Infect Dis. 1973 Jan;127(1):102-5 PMID: 4566620
  9. Pseudomonas aeruginosa compared with Escherichia coli produces less endotoxemia but more cardiovascular dysfunction and mortality in a canine model of septic shock.
    Chest. 1990 Dec;98(6):1480-7 PMID: 2245691
  10. Tachypleus lysate test for endotoxin in patients with Gram negative bacterial infections.
    Southeast Asian J Trop Med Public Health. 1979 Mar;10(1):13-7 PMID: 483008
  11. Predictors of bacteremia and gram-negative bacteremia in patients with sepsis. The Veterans Affairs Systemic Sepsis Cooperative Study Group.
    Arch Intern Med. 1992 Mar;152(3):529-35 PMID: 1546915
  12. A comparison of methods of removing inhibitors to the chromogenic Limulus assay in normal and jaundiced blood.
    Thromb Res. 1986 Oct 1;44(1):95-100 PMID: 3024353
  13. Plasma Limulus gelation assay in infants and children: correlation with gram negative bacterial infection and evidence for "intestinal endotoxemia".
    Prog Clin Biol Res. 1985;189:329-45 PMID: 4048212
  14. Endotoxemia during percutaneous manipulation of the obstructed biliary tree.
    Am J Surg. 1989 Jul;158(1):21-4 PMID: 2742045
  15. Sepsis management and antiendotoxin therapy after nebacumab. A reappraisal.
    Drugs. 1994 Jun;47(6):855-61 PMID: 7521827
  16. Yersinia pestis infection in Vietnam. II. Quantiative blood cultures and detection of endotoxin in the cerebrospinal fluid of patients with meningitis.
    J Infect Dis. 1976 May;133(5):493-9 PMID: 1262715
  17. Limulus amoebocyte lysate endotoxin test: an aid to the diagnosis in the septic neonate?
    J Infect. 1982 Jan;4(1):69-72 PMID: 7185978
  18. Effectiveness of a human monoclonal anti-endotoxin antibody (HA-1A) in gram-negative sepsis: relationship to endotoxin and cytokine levels.
    J Infect Dis. 1992 Dec;166(6):1367-74 PMID: 1431255
  19. Meningococcal endotoxin in lethal septic shock plasma studied by gas chromatography, mass-spectrometry, ultracentrifugation, and electron microscopy.
    J Clin Invest. 1992 Mar;89(3):816-23 PMID: 1541674
  20. Endotoxinemia and thrombocytopenia during neonatal necrotizing enterocolitis.
    Am J Clin Pathol. 1985 Feb;83(2):227-9 PMID: 3881930
  21. Endotoxaemia in septic shock: clinical and post mortem correlations.
    Intensive Care Med. 1983;9(3):117-22 PMID: 6863720
  22. Selective decontamination of the digestive tract reduces gram-negative pulmonary colonization but not systemic endotoxemia in patients undergoing elective liver transplantation.
    Crit Care Med. 1994 Jan;22(1):40-9 PMID: 8124972
  23. Plasma endotoxin as a predictor of multiple organ failure and death in systemic meningococcal disease.
    J Infect Dis. 1989 Feb;159(2):195-204 PMID: 2492587
  24. Endotoxemia associated with cardiopulmonary bypass.
    J Thorac Cardiovasc Surg. 1987 Jun;93(6):832-7 PMID: 3573796
  25. [Endotoxemia and malnutrition].
    Minerva Pediatr. 1977 Feb 28;29(2):139-42 PMID: 403401
  26. The Limulus test in experimental and clinical endotoxaemia.
    Br J Surg. 1974 Oct;61(10):798-804 PMID: 4607279
  27. A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock.
    N Engl J Med. 1987 Sep 10;317(11):653-8 PMID: 3306374
  28. [Contribution of the "limulus test" to the diagnosis of endotoxemias and meningitis due to gram negative bacteria].
    Nouv Presse Med. 1976 Apr 23;6(17):1451-4 PMID: 1030787
  29. Presence of endotoxemia and its relationship to liver dysfunction in patients with typhoid fever.
    Infection. 1987;15(5):359-62 PMID: 3692608
  30. The Limulus test and gram-negative bacillary sepsis.
    Am J Dis Child. 1974 Aug;128(2):172-4 PMID: 4855168
  31. Clinical evaluation of the plasma chromogenic Limulus assay.
    Prog Clin Biol Res. 1987;231:405-16 PMID: 3588633
  32. Endotoxin clearance by exchange blood transfusion in septic shock neonates.
    Acta Paediatr Scand. 1983 Jan;72(1):87-91 PMID: 6344552
  33. Hyperlipidemic response to endotoxin--a part of the host-defence mechanism.
    Scand J Infect Dis. 1993;25(6):675-82 PMID: 8052806
  34. Typhoid fever. Studies of blood coagulation, bacteremia, and endotoxemia.
    Arch Intern Med. 1978 Mar;138(3):407-10 PMID: 629635
  35. Endotoxin liberation and invasivity of Neisseria meningitidis.
    Scand J Infect Dis. 1984;16(3):247-54 PMID: 6436962
  36. Endotoxemia, bacteremia and urosepsis.
    Prog Clin Biol Res. 1988;272:213-24 PMID: 3393563
  37. Optimization of detection of bacterial endotoxin in plasma with the Limulus test.
    J Lab Clin Med. 1990 Aug;116(2):153-61 PMID: 2203854
  38. Detection of endotoxin in the plasma of patients with gram-negative bacterial sepsis by the Limulus amoebocyte lysate assay.
    J Clin Microbiol. 1985 Jun;21(6):865-8 PMID: 4008617
  39. Endotoxemia in human septic shock.
    Chest. 1991 Jan;99(1):169-75 PMID: 1984950
  40. A STUDY OF THE RELATIONSHIP OF THE NORMAL BACTERICIDAL ACTIVITY OF HUMAN SERUM TO BACTERIAL INFECTION.
    J Clin Invest. 1960 Jan;39(1):72-81 PMID: 16695824
  41. Prognostic significance of endotoxin determination in patients with severe intraabdominal infection.
    J Infect Dis. 1990 Jun;161(6):1314-5 PMID: 2345311
  42. Evaluation of the Limulus test for endotoxemia in neonates with suspected sepsis.
    J Pediatr. 1981 Jun;98(6):899-903 PMID: 7229791
  43. Endotoxin liberation by strains of N. meningitidis isolated from patients and healthy carriers.
    Epidemiol Infect. 1991 Apr;106(2):289-95 PMID: 1902183
  44. Bubonic plague: detection of endotoxemia with the limulus test.
    Ann Intern Med. 1973 Nov;79(5):642-6 PMID: 4584566
  45. Survival in selected patients with gram-negative sepsis after adjunctive therapy with HA-1A.
    Lancet. 1993 Apr 10;341(8850):959-60 PMID: 8096292
  46. Use of the Limulus amebocyte lysate test as a cost-effective screen for gram-negative agents of meningitis.
    Diagn Microbiol Infect Dis. 1987 Jul;7(3):177-83 PMID: 3115674
  47. Gram-negative sepsis: detection of endotoxemia with the limulus test. With studies of associated changes in blood coagulation, serum lipids, and complement.
    Ann Intern Med. 1972 Jan;76(1):1-7 PMID: 5021550
  48. Cost-effectiveness of HA-1A monoclonal antibody for gram-negative sepsis. Economic assessment of a new therapeutic agent.
    JAMA. 1991 Dec 25;266(24):3466-71 PMID: 1744962
  49. Statistical aspects of the analysis of data from retrospective studies of disease.
    J Natl Cancer Inst. 1959 Apr;22(4):719-48 PMID: 13655060
  50. Circulating endotoxin and tumor necrosis factor during pediatric cardiac surgery.
    Crit Care Med. 1992 Aug;20(8):1090-6 PMID: 1643887
  51. Endotoxaemia and serum tumour necrosis factor as prognostic markers in severe acute pancreatitis.
    Gut. 1992 Aug;33(8):1126-8 PMID: 1398241
  52. Serial quantitation of endotoxemia and bacteremia during therapy for gram-negative bacterial sepsis.
    J Infect Dis. 1988 Mar;157(3):565-8 PMID: 3343526
  53. Studies on the mechanism of bacterial resistance to complement-mediated killing. I. Terminal complement components are deposited and released from Salmonella minnesota S218 without causing bacterial death.
    J Exp Med. 1982 Mar 1;155(3):797-808 PMID: 6801179
  54. Detection of endotoxin in the blood of patients with sepsis due to gram-negative bacteria.
    N Engl J Med. 1970 Dec 10;283(24):1313-6 PMID: 5478453
  55. Clearance of endotoxin by platelets: role in increasing the accuracy of the Limulus gelation test and in combating experimental endotoxemia.
    Surgery. 1973 Aug;74(2):235-40 PMID: 4577805
  56. Interaction of complement with serum-sensitive and serum-resistant strains of Pseudomonas aeruginosa.
    Infect Immun. 1986 Dec;54(3):689-94 PMID: 3096887
  57. The capsular polysaccharide is a major determinant of serum resistance in K-1-positive blood culture isolates of Escherichia coli.
    Infect Immun. 1990 Jan;58(1):222-7 PMID: 2403532
  58. Clinical experience in detecting endotoxemia with the limulus test in typhoid fever and other Salmonella infections.
    Infection. 1976;4(2):21-4 PMID: 977132
  59. Detection of endotoxemia with the Limulus test: preliminary studies in severely malnourished children.
    J Pediatr. 1974 Oct;85(4):570-3 PMID: 4216626
  60. ENDOTOXIN-LIKE ACTIVITY OF SERUM FROM PATIENTS WITH SEVERE LOCALIZED INFECTIONS.
    N Engl J Med. 1964 Aug 27;271:445-7 PMID: 14171815
  61. Quantitative Limulus lysate assay for endotoxin and the effect of plasma.
    J Clin Pathol. 1991 Oct;44(10):849-54 PMID: 1960219
  62. Endotoxin and bacteria in portal blood.
    Gastroenterology. 1977 Jun;72(6):1268-70 PMID: 858472
  63. Limitations of the usefulness of the Limulus assay for endotoxin.
    N Engl J Med. 1973 Jun 14;288(24):1261-4 PMID: 4574106
  64. Quantitation of endotoxin in blood from patients with meningococcal disease using a limulus lysate test in combination with chromogenic substrate.
    Infection. 1983 Jul-Aug;11(4):192-5 PMID: 6352508
  65. Detection of endotoxin in human blood and demonstration of an inhibitor.
    J Lab Clin Med. 1970 Jun;75(6):903-11 PMID: 5421075
  66. Beta blockade during and after myocardial infarction: an overview of the randomized trials.
    Prog Cardiovasc Dis. 1985 Mar-Apr;27(5):335-71 PMID: 2858114
  67. Endotoxin levels in immunocompromised children with fever.
    J Pediatr. 1986 Aug;109(2):265-9 PMID: 3734963
  68. Lack of clinical usefulness of the limulus test in the diagnosis of endotoxemia.
    N Engl J Med. 1975 Sep 11;293(11):521-4 PMID: 1152876
  69. Endotoxaemia: an early predictor of septicaemia in febrile patients.
    Lancet. 1988 Mar 19;1(8586):605-9 PMID: 2894546
  70. Endotoxin liberation from Neisseria meningitidis correlates to their ability to induce procoagulant and fibrinolytic factors in human monocytes.
    Scand J Infect Dis. 1993;25(5):585-94 PMID: 8284643
  71. Treatment of gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody against endotoxin. A randomized, double-blind, placebo-controlled trial. The HA-1A Sepsis Study Group.
    N Engl J Med. 1991 Feb 14;324(7):429-36 PMID: 1988827
  72. Patterns of cytokines, plasma endotoxin, plasminogen activator inhibitor, and acute-phase proteins during the treatment of severe sepsis in humans.
    Crit Care Med. 1992 Feb;20(2):185-92 PMID: 1371097
  73. Presence of circulating endotoxins during cardiac operations.
    J Thorac Cardiovasc Surg. 1987 Jan;93(1):115-9 PMID: 3025527
Article Info
Journal
Journal of clinical microbiology
Abbr.
J Clin Microbiol
ISSN
0095-1137
DOI
10.1128/jcm.32.9.2120-2127.1994
Published
1994-09-00
Pages
2120-7
Language
English
Region
United States
NLM ID
7505564
PMCID
PMC263953
Subset
IM
External Links
PubMed source DOI: 10.1128/jcm.32.9.2120-2127.1994 PMC Full Text View journal details
Analysis Services
Analysis Services

Contact

No. 2 Wenbo Road, Zhangqiu District, Jinan, Shandong

Qilu Normal University · Genelibs Bioinformatics Lab

750 Shunhua Rd, Jinan

2F, Bldg F, University Science Park

Tel: 0531-88819269

WeChat Official Account

Follow our WeChat subscription account for real-time updates and the latest in medical and biological research.


Business Email

E-mail: product@genelibs.com

Copyright © 2026.Genelibs Jinan Honghui Biotechnology Co., Ltd. 鲁ICP备20007159号-2