Related Experiment Video
Updated: Jun 1, 2026
Endotoxin Activity Assay for the Detection of Whole Blood Endotoxemia in Critically Ill Patients
Published on: June 24, 2019
Endotoxemia in pediatric critical illness--a pilot study
Shamik Dholakia1, David Inwald, Helen Betts
1Department of Paediatric Intensive Care, St Mary's Hospital, Imperial College Healthcare NHS Trust and Imperial College London, Praed Street, London, UK.
Insights
Endotoxemia is common in critically ill children. While not linked to death, it may increase illness severity and PICU length of stay.
Area of Science:
- Pediatric Intensive Care
- Critical Care Medicine
- Infectious Diseases
Background:
- Endotoxemia is a significant concern in pediatric intensive care units (PICU).
- Investigating endotoxemia prevalence and its impact on disease severity and outcomes in children is crucial.
Purpose of the Study:
- To determine the prevalence of endotoxemia in children admitted to the PICU.
- To assess the association between endotoxemia and disease severity, including organ dysfunction and mortality.
- To explore the relationship between endotoxemia and the length of PICU stay.
Main Methods:
- A prospective, observational cohort study involving 100 consecutive children admitted to a PICU.
- Collected demographic and clinical data, assessing illness severity using Pediatric Index of Mortality 2 (PIM2) and Pediatric Logistic Organ Dysfunction (PELOD) scores.
- Measured endotoxemia using the endotoxin activity assay (EAA) within 24 hours of admission, stratifying patients by EAA level and primary diagnosis.
Main Results:
- Fifty-five children (55%) presented with endotoxemia upon PICU admission, predominantly associated with infectious causes (75%).
- Endotoxemia was significantly linked to an infectious cause of admission (P < 0.005) but not directly to shock or death.
- A trend towards increased PELOD scores and longer PICU stays was observed in endotoxemic children.
Conclusions:
- Endotoxemia is a frequent finding in critically ill children within the PICU.
- Further research into the implications of endotoxemia and anti-endotoxin therapies could potentially mitigate illness severity and reduce PICU length of stay.
Introduction:
The aim was to investigate the prevalence of endotoxemia in children admitted to pediatric intensive care unit (PICU), and its association with disease severity and outcome.
Methods:
We conducted a prospective, observational cohort study of children admitted to PICU at St. Mary's Hospital, London over a 6-month period. One hundred consecutive patients were recruited. Demographic and clinical data were collected. Severity of illness was assessed by the pediatric index of mortality 2 (PIM2) score. The pediatric logistic organ dysfunction (PELOD) score was performed daily for the first 4 days. Patients were categorized according to primary reason for PICU admission. Blood samples were taken within 24 hours of admission and endotoxemia was measured using the endotoxin activity assay (EAA). Patients were stratified according to EAA level (high, EAA > 0.4, low, EAA < 0.4) and categorized as septic, post-surgical, respiratory or other. Data were analyzed using appropriate non-parametric tests.
Results:
EAA level was significantly lower in PICU controls versus other PICU admissions (P = 0.01). Fifty-five children had endotoxemia on admission. Forty-one (75%) of these were eventually diagnosed with an infectious cause of admission. Nine children without infection had elevated EAA on admission. An infectious cause of admission was significantly associated with endotoxemia (P < 0.005). Of 15 children with gram-negative infection, only 9 (60%) had endotoxemia on admission. Endotoxemia on admission was not associated with shock or death. However, there was a tendency for increased PELOD score and length of stay in endotoxemic children.
Conclusions:
Endotoxemia is common in children admitted to intensive care. Understanding the implications of endotoxemia and potential anti-endotoxin strategies may have the potential to reduce severity of illness and length of PICU stay in critically ill children.
