Endotoxaemia, fever and clinical status in immunosuppressed patients: a preliminary study

A prospective study was performed in order to find out whether endotoxaemia assays are clinically relevant in neutropenic patients. In a group of 10 immunocompromised patients, serial haematological, bacteriological and clinical investigations were done in parallel with serial plasma endotoxin assays. The chromogenic modification of the Limulus amoebocyte lysate (LAL) assay for endotoxin used in this study had a sensitivity of less than 10 pg endotoxin per ml plasma. It was found that endotoxaemia was associated with Gram-negative bacteraemia but infection with Gram-negative bacteria did not always produce endotoxaemia. Furthermore, infections with Gram-positive bacteria and administration of blood products may lead to raised endotoxin values. Endotoxin assays may be of value for elucidating mechanisms of fever in immunocompromised patients but it seems unlikely that routine assays of endotoxin will help in the clinical management of these patients.