ENDOTOXIN ACTIVITY LEVELS AS A PREDICTION TOOL FOR RISK OF DETERIORATION IN PATIENTS WITH SEPSIS NOT ADMITTED TO THE ICU: A PILOT OBSERVATIONAL STUDY

ABSTRACT Purpose: The aim of this prospective observational study was to evaluate in patients with sepsis not requiring ICU admission the relationship between the levels of endotoxin activity assay (EAA) early after sepsis recognition and the risk of development of organ dysfunction (OD). Methods: EAA levels were drawn immediately after sepsis identification (baseline) and at 6, 24, and 48 hours post-baseline in 50 patients with signs of sepsis of a duration of less than 24 hours. An EAA ≥ 0,60 units was considered as highly elevated. Results: Logistic regression showed independent association between EAA levels at baseline and the appearance of new OD (adjusted OR 2,41; 95% CI 1,18-4,90; p<0,05). 15 patients (30%) who developed new OD after baseline had at least one EAA level ≥ 0,60. The adjusted linear regression analysis showed that across the 4 time points EAA levels were significantly higher in patients who developed new OD (0,11; 95% CI 0,01-0,20, p<0,05). Conclusions. EAA levels ≥ 0,60 early after sepsis diagnosis in patients not requiring ICU admission predicts risk of development of new organ dysfunction. High EAA levels in the first 48 hours of recognition of sepsis are also predictive of risk of deterioration.