Related Experiment Video
Updated: Mar 28, 2026
Endotoxin Activity Assay for the Detection of Whole Blood Endotoxemia in Critically Ill Patients
Published on: June 24, 2019
Evaluation of Endotoxemia After Pediatric Cardiac Surgery With the Endotoxin Activity Assay: An Exploratory
Zaccaria Ricci1, Roberta Haiberger, Chiara Pezzella
1Pediatric Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Insights
Endotoxin assay activity levels frequently exceed normal ranges in infants after cardiac surgery with cardiopulmonary bypass, peaking 24-48 hours postoperatively. These elevated levels correlate with impaired organ perfusion but do not reliably predict Gram-negative infections.
Area of Science:
- Pediatric Cardiac Surgery
- Critical Care Medicine
- Infectious Disease Markers
Background:
- Infants undergoing cardiac surgery with cardiopulmonary bypass face a high risk of perioperative endotoxemia.
- Understanding endotoxin levels is crucial for managing postoperative complications in this vulnerable population.
Purpose of the Study:
- To prospectively evaluate endotoxin assay activity reference levels in infants post-cardiac surgery.
- To assess the association between endotoxin levels, perioperative variables, and postoperative infections.
Main Methods:
- Prospective, single-center cohort study involving infants undergoing cardiac surgery with cardiopulmonary bypass.
- Serial endotoxin assay activity measurements at baseline, ICU arrival, and postoperative days 1 and 2.
- Exclusion of patients with preoperative infection, ECMO/VAD support, heart transplantation, or urgent surgery.
Main Results:
- 58% of patients (14/25) had endotoxin assay activity > 0.4.
- Endotoxin levels significantly increased from baseline to postoperative days 1 and 2 (p < 0.0001).
- Elevated endotoxin levels (>0.6) were associated with longer ventilation days (median 8 vs 1.5, p=0.02) and impaired organ perfusion markers.
Conclusions:
- Endotoxin assay activity levels are frequently elevated post-cardiac surgery in infants, peaking 24-48 hours after bypass.
- Increased endotoxin levels appear linked to perioperative impaired organ perfusion.
- Endotoxin assay activity was not found to be a useful predictor of Gram-negative infections in this cohort.
Objective:
Children with congenital heart diseases undergoing surgery with cardiopulmonary bypass are exposed to a high risk of perioperative endotoxemia. The aim of our study was to prospectively evaluate endotoxin assay activity reference levels during the postoperative phase of infants undergoing cardiac surgery for congenital heart disease and to assess their association with perioperative variables and postoperative infections.
Design:
Prospective exploratory single-center cohort study.
Setting:
Tertiary pediatric cardiac ICU.
Patients:
Infants undergoing cardiac surgery with cardiopulmonary bypass were enrolled. Exclusion criteria were preoperative suspected or confirmed infection, the need for extracorporeal membrane oxygenation or a ventricular assist device in any perioperative phase, surgery for heart transplantation, and/or urgent surgery.
Interventions:
Serial measurements of endotoxin assay activity were performed at baseline, pediatric cardiac ICU arrival, postoperative day 1 and 2.
Measurements And Main Results:
Twenty-five patients were enrolled. Overall, 14 of 25 patients (58%) presented at least one endotoxin assay activity level greater than 0.4 during the study period (normal level is < 0.4). Endotoxin assay activity levels tended to significantly increase from baseline to postoperative day 1 and 2 and from pediatric cardiac ICU arrival to postoperative day 2 (p < 0.0001). Endotoxin assay activity greater than 0.6 predicted Gram-negative infections with a sensitivity of 0.40, a specificity of 0.95, a positive predictive value of 0.66, and a negative predictive value of 0.86. At multivariable regression, endotoxin assay activity on postoperative day 1 resulted independently associated with cardiopulmonary bypass duration, lactate, temperature peak, and vasoactive inotropic score at pediatric cardiac ICU arrival. Children with endotoxin assay activity levels greater than 0.6 (vs all the others) showed a significantly higher median (interquartile) number of ventilation days: 8 (2-39) versus 1.5 (1-3 (p = 0.02).
Conclusions:
This exploratory study showed that endotoxin assay activity levels in infants undergoing cardiopulmonary bypass are frequently above 0.4 and peak 24-48 hours after surgery and appear to be associated with perioperative impaired organ perfusion. Endotoxin assay activity is not useful to predict Gram-negative infections.
Related Concept Videos
01:29Endocarditis IV: Nursing Management
01:18Endocarditis III: Medical Management