EVALUATION OF PROGNOSTIC SIGNIFICANCE OF BLOOD ENDOTOXIN ACTIVITY INDICATOR IN PATIENTS WITH SEPSIS

Introduction. Laboratory indicators of endotoxinemia in conjunction with the clinical picture have been used as the criteria to diagnosticate sepsis for quite a long time. The objective of the study is to analyze the prognostic significance of endotoxin activity indicator in patients with sepsis that undergo treatment in conditions of surgical resuscitation and intensive care at multidisciplinary hospital.

Materials and methods. One-center prospective study on the basis of ICU department of the Republic Clinical Hospital (Ufa, Russia) during the period of 2015- 2016. We have performed screening of 60 patients with sepsis and 15 healthy volunteers.

Results. The median of the value of endotoxin activity in group of patients with sepsis amounted to 0.42 vs. 0.1 of group of healthy volunteers. It was found that the level of endotoxin activity correlates with the severity of the disease: low scores on the scale of the APACHE II severity are consistent with low endotoxin activity (r=0.985, r2=0.971, p=0.0001). Findings show that the median of sensitivity of the medical test corresponds to 87.5% and that of specificity - to 32.6%. The prognostic value of a positive result amounted to 27.5%, and the prognostic value of a negative result - 97.8%. The area under the ROC-curve for the level of endotoxin activity is equal to 0.749±0.084, 95% confidence interval (CI) 0.620-0.852. Sensitivity-61.5% (54.8-86.0), specificity is 93.6% (82.4-98.6). The optimum point of separation was 0.88. Positive predictive level amounted to 72.7%, negative one - 89.8%.

Conclusions. The test to determine the level of endotoxin activity of blood has high sensitivity and negative prognostic value, allowing you to use it as an effective screening method to assess the probable invasion of gram-negative flora, days before the results of bacteriological research are available. 

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