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Related Experiment Video

Updated: Sep 9, 2025

Endotoxin Activity Assay for the Detection of Whole Blood Endotoxemia in Critically Ill Patients
06:28

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Organ Failure, Endotoxin Activity, and Mortality in Septic Shock.

Luca Molinari1, Mark A Tidswell2, Ali Al-Khafaji3

  • 1Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy.

Critical Care Explorations
|August 28, 2025
PubMed
Summary

High endotoxin activity and organ failure in septic shock patients indicate a significantly increased risk of death. This combination, termed endotoxic septic shock (ESS), identifies a critical subgroup for targeted sepsis therapies.

Keywords:
endotoxinmultiple organ failurepolymyxin Bsepsisseptic shock

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Area of Science:

  • Critical care medicine
  • Infectious diseases
  • Immunology

Background:

  • The interplay between endotoxin activity, organ dysfunction, and mortality in sepsis remains incompletely understood.
  • Identifying high-risk sepsis patient subgroups is crucial for effective treatment strategies.

Purpose of the Study:

  • To investigate if combining endotoxin activity and organ failure scores predicts higher mortality in septic shock.
  • To correlate these findings with established sepsis phenotypes.

Main Methods:

  • Prospective observational study involving critically ill patients with septic shock across four ICUs.
  • Assessed endotoxin activity assay (EAA), Sequential Organ Failure Assessment (SOFA), and Multiple Organ Dysfunction Score (MODS).
  • Analyzed 28-day mortality rates in relation to EAA, SOFA, and MODS levels.

Main Results:

  • Endotoxic septic shock (ESS), defined by EAA ≥ 0.6 and SOFA > 11 or MODS > 9, was identified in 21 patients (24.4%).
  • ESS patients exhibited a significantly higher 28-day mortality rate (57.1%) compared to non-ESS patients (15.9%), with a relative risk of death of 3.58.
  • A significant association was found between ESS and the delta sepsis phenotype (33.3% vs 5.8%).

Conclusions:

  • Endotoxic septic shock represents a distinct sepsis subgroup with a markedly elevated mortality risk.
  • Patients with ESS are the primary candidates for clinical trials evaluating anti-endotoxin therapies to improve sepsis survival.