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[The interconnection between the severity of meningococcal infection and the endotoxicity levels and patient's blood
Abstract:
Seventy-eight patients with severe systemic meningococcal disease admitted to the Intensive Care Unit of the Second Moscow Hospital for Infectious Diseases were divided into four groups by complications of their disease: patients with refractory septic shock (RSS)--group 1; patients with early septic shock (ESS)--group 2; patients without shock but with severe mental disorders--group 3; patients without any of these complications--group 4. The LPS concentration in plasma was assessed by chromogenic method. Initial LPS levels in plasma of group 3 or group 4 patients (170 ng/l, median value and 360 ng/l, respectively) were greater than those of healthy donors (LPS < 15 ng/l). LPS concentration was significantly greater in group 2 (920 ng/l) or group 1 (12,400 ng/l). LPS levels declined exponentially in all the patients. The half-life was calculated to be 1.4 (+) -0.3 h. In group 2 and 1, respectively, the classical pathway complement activity in patients' serum was 50 and 10% of normal control values. To estimate significant prognostic factors for fatality in our patients, specificity and factor fatality difference of various clinical and laboratory factors were calculated. The cut-off LPS value for development of ESS was 600 ng/l and that for development of RSS and death was 8000 ng/l. For the prediction of fatality using the former cut-off value of LPS, sensitivity was 84% and specificity 100%. Using plasma complement activity (cut-off--15% of normal value) for prediction, sensitivity was 75% and specificity was 100%. Other factors (platelet and WBC count, blood pH, BP, etc.) had lower predictive power. Thus to date plasma endotoxin level and complement activity are the best prognostic factors in meningococcal disease.
Insights
High plasma lipopolysaccharide (LPS) levels and low complement activity are key indicators of severe meningococcal disease. These factors significantly predict patient outcomes and fatality risk in critical care settings.
Area of Science:
- * Infectious Diseases
- * Critical Care Medicine
- * Immunology
Background:
- * Severe systemic meningococcal disease presents with significant complications, including septic shock and mental disorders.
- * Lipopolysaccharide (LPS), an endotoxin, is a key component of the outer membrane of Gram-negative bacteria like Neisseria meningitidis.
- * The body's immune response, particularly the complement system, plays a crucial role in managing bacterial infections.
Purpose of the Study:
- * To evaluate plasma lipopolysaccharide (LPS) concentration and complement activity as prognostic factors in severe meningococcal disease.
- * To determine the predictive value of LPS levels and complement activity for the development of early septic shock (ESS), refractory septic shock (RSS), and fatality.
- * To compare the prognostic power of LPS and complement activity with other clinical and laboratory parameters.
Main Methods:
- * Seventy-eight patients with severe meningococcal disease were categorized into four groups based on disease complications.
- * Plasma LPS concentration was measured using a chromogenic method.
- * Classical pathway complement activity was assessed, and various clinical and laboratory factors were analyzed for prognostic significance.
Main Results:
- * LPS levels were significantly elevated in patients with ESS (920 ng/l) and RSS (12,400 ng/l) compared to those without shock (170-360 ng/l) and healthy donors (<15 ng/l).
- * A cut-off LPS value of 600 ng/l predicted ESS with 84% sensitivity and 100% specificity; a cut-off of 8000 ng/l predicted RSS and death.
- * Plasma complement activity below 15% of normal predicted fatality with 75% sensitivity and 100% specificity, outperforming other clinical factors.
Conclusions:
- * Plasma LPS concentration and complement activity are the most significant prognostic factors identified for severe meningococcal disease.
- * These biomarkers can effectively predict the development of severe complications like septic shock and patient fatality.
- * Monitoring LPS levels and complement activity in critically ill patients can aid in risk stratification and management decisions.