[Postoperative determination of endotoxin levels. Prognostic and diagnostic value in intensive care units]

197 patients monitored postoperatively for more than two days in an intensive-care unit were followed up prospectively for nine months. Endotoxin plasma levels were determined daily by means of the limulus amoebocyte lysate test. In endotoxin-positive patients there was a statistically significantly higher incidence of peritonitis, sutural insufficiency, pneumonia, and sepsis. The diagnostic value of the test was found to be higher if the patients were considered "septic" only when endotoxin was positive for more than two days. In that case the specificity of the test was 80.6%; this was superior to that of a corresponding rise in leukocyte count or in body temperature. The positive predictive value for septic complications was 67.6%. Determination of the course of the endotoxin titre is more relevant than recording an isolated rise. This allows differentiation between septic and non-septic diseases.