Usefulness of the endotoxin activity assay to evaluate the degree of lung injury
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Abstract
A major problem of the techniques used for quantifying endotoxin levels has been their low sensitivity. To address this problem, a diagnostic kit called Endotoxin Activity Assay (EAATM) was developed. The degree of lung injury must be determined when formulating treatment strategies for patients with sepsis and prognosticating the outcome of this condition. Based on the observations described above, we hypothesize that endotoxin can serve as an important biomarker in evaluating lung injury. Currently, lung injuries in patients with septic shock or ARDS can be assessed by cardiorespiratory monitoring. One such monitoring system is called Pulse index Continuous Cardiac Output (PiCCO). It measures cardiac output (CO) using a thermodilution technique that employs a cold thermal indicator. It then calculates CO per beat using pulse contour analysis. Importantly, PiCCO can also measure extravascular lung water (EVLW) and the pulmonary vascular permeability index (PVPI) that reflect the severity of lung injury. PVPI was significantly higher in patients with high EAA levels than in those with normal EAA levels (3.55 ± 0.48 vs. 1.99 ± 0.68, p = 0.0029). In addition, the patient group with high PCT levels showed significantly lower cardiac indices than the group with normal PCT levels (3.40 ± 1.05 vs. 4.80 ± 0.39, p = 0.0325). he results described above indicate that the EAA level is closely correlated with the degree of lung injury assessed by the PiCCO monitor. This suggests that EAA could also be used as a valuable tool in monitoring lung injury.
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References
(1) Ashbaugh DG, Bigelow DB, Petty TL, et al. Acute respiratory distress in adults. Lancet 1967; 2: 319-23.
(2) Murray JF, Matthay MA, Luce JM, et al. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 1988; 138: 720-3
(3) Bernard GR, Artigas A, Brigham KL, et al. Report of the American-European Consensus conference on acute respiratory distress syndrome: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Consensus Committee. J Crit Care 1994; 9: 72-81
(4) ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012; 307: 2526-33.
(5) Thille AW, Esteban A, Fernandez-Segoviano P, et al. Comparison of the Berlin definition for acute respiratory distress syndrome with autopsy. Am J Respir Crit Care Med 2013; 187: 761-7
(6) Cressoni M, Cadringher P, Chiurazzi C, et al. Lung inhomogeneity in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 2014; 189: 149-58.
(7) Ichikado K. High-resolution computed tomography findings of acute respiratory distress syndrome, acute interstitial pneumonia, and acute exacerbation of idiopathic pulmonary fibrosis. Semin Ultrasound CT MR 2014; 35: 39-46
(8) Boissier F, Katsahian S, Razazi K, et al. Prevalence and prognosis of corpulmonale during protective ventilation for acute respiratory distress syndrome. Intensive Care Med 2013; 39: 1725-33.
(9) National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 2006; 354: 2564-75.
(10) Binnie A, Tsang JL, dos Santos CC. Biomarkers in acute respiratory distress syndrome. Curr Opin Crit Care 2014; 20: 47-55.
(11) Bhargava M, Wendt CH. Biomarkers in acute lung injury. Transl Res 2012; 159: 205-17.
(12) Barnett N, Ware LB. Biomarkers in acute lung injury-marking forward progress. Crit Care Clin 2011; 27: 661-83.
(13) Katagiri D, Doi K, Matsubara T, et al. New biomarker panel of plasma neutrophil gelatinase-associated lipocalin and endotoxin activity assay for detecting sepsis in acute kidney injury. J Crit Care 2013; 28: 564-70.
(14) World Sepsis Day Head Office Global Sepsis Alliance Center for Sepsis Control & Care Erlanger Allee 101 07747 Jena Germany T +49 3641 9323101 F +49 3641 9323102 E [email protected] www.world-sepsis-day.org
(15) Vin Vincent JL, Sakr Y, Sprung CL, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 2006; 34: 344-53.
(16) Opal SM, Dellinger RP, Vincent JL, et al. The next generation of sepsis clinical trial designs: what is next after the demise of recombinant human activated protein C?*. Crit Care Med. 2014; 42: 1714-21.
(17) Cutuli SL, Artigas A, Fumagalli R, et al. Polymyxin-B hemoperfusion in septic patients: analysis of a multicenter registry. Ann Intensive Care. 2016: 77. doi: 10.1186/s13613-016-0178-9. Epub 2016 Aug 8.
(18) Hanasawa K1, Aoki H, Yoshioka T, et al. Novel mechanical assistance in the treatment of endotoxic and septicemic shock. ASAIO Trans. 1989; 35: 341-3.
(19) Ronco C, Klein DJ. Polymyxin B hemoperfusion: a mechanistic perspective. Crit Care. 2014; 18: 309. doi: 10.1186/cc13912.
(20) Romaschin AD, Klein DJ, Marshall JC. Bench-to-bedside review: Clinical experience with the endotoxin activity assay. Crit Care. 2012; 16: 248. doi: 10.1186/cc11495.
(21) Sakamoto Y, Inoue S, Iwamura T, et al. Usefulness of the endotoxin activity assay to evaluate the degree of lung injury. Yonsei Med J. 2014 ;55 :975-9.
(22) Ritter S, Rudiger A, Maggiorini M. Transpulmonary thermodilution-derived cardiac function index identifies cardiac dysfunction in acute heart failure and septic patients: an observational study. Crit Care 2009;13:R133.
(23)