Yonsei Med J.  2014 Jul;55(4):975-979. 10.3349/ymj.2014.55.4.975.

Usefulness of the Endotoxin Activity Assay to Evaluate the Degree of Lung Injury

• Sakamoto Y
• Inoue S
• Iwamura T
• Yamashita
• Nakashima
• Koami H
• Miike T
• Yahata M
• Imahase H
• Goto A
• Narumi S
• Ohta M
• Yamada CK

• KMID: 2130822
• DOI: http://doi.org/10.3349/ymj.2014.55.4.975

Abstract

PURPOSE
It has been reported that the Pulse Contour Cardiac Output (PiCCO) is very useful mainly in the field of intensive care and treatment to grasp the pathophysiological conditions of pulmonary edema because of its capability of obtaining data such as Pulmonary Vascular Permeability Index (PVPI) and Extra Vascular Lung Water (EVLW). Furthermore, a high degree of usability of various markers has been reported for better understanding of the pathological conditions in cases with septicemia.
MATERIALS AND METHODS
The correlation between the cardiorespiratory status based upon the PiCCO monitor (EVLW and PVPI) and inflammatory markers including C reactive protein, procalcitonin (PC), and Endotoxin Activity Assay (EAA) were evaluated in 11 severe cases that required treatment with a respirator in an intensive care unit.
RESULTS
The EAA values were significantly higher in patients with abnormal EVLW at 0.46+/-0.20 compared to the normal EVLW group at 0.21+/-0.19 (p=0.0064). In a similar fashion, patients with abnormal PVPI values tended to have higher PC levels at 18.9+/-21.8 compared to normal PVPI cases at 2.4+/-2.2 (p=0.0676). On the other hand, PVPI was significantly higher in the abnormal EAA group at 3.55+/-0.48 in comparison with the normal EAA group at 1.99+/-0.68 (p=0.0029). The abnormal EAA group tended to have higher PVPI values than the normal EAA group.
CONCLUSION
The EAA is a measurement method designed to estimate the activity of endotoxins in the whole blood. Our results suggest that the EAA value, which had the greatest correlation with lung disorders diagnosed by the PiCCO monitoring, reflects inflammatory reactions predominantly in the lungs.

Keyword

Pulse Contour Cardiac Output (PiCCO); CRP; procalcitonin; Endotoxin Activity Assay (EAA)

MeSH Terms

Adult
Aged
Aged, 80 and over
Cardiac Output/physiology
Endotoxins/*blood
Female
Humans
Lung Injury/*blood/*diagnosis/physiopathology
Male
Middle Aged
Pulmonary Edema/blood/*diagnosis/physiopathology
Endotoxins

Figure

• 

  Fig. 1 Relationship between EVLW and inflammatory marker. The EAA values were significantly higher in the EVLW-A at 0.46±0.20 compared to the EVLW-N at 0.21±0.19 (p=0.0064) and no correlations between EVLW and PC or CRP were observed. EAA, Endotoxin Activity Assay; PC, procalcitonin; CRP, C reactive protein; EVLW, Extra Vascular Lung Water.

• 

  Fig. 2 Relationship between PVPI and inflammatory marker. The PVPI-A tended to have higher PC levels at 18.9±21.8 compared to PVPI-N at 2.4±2.2 (p=0.0676), and no correlations between PVPI level and EAA or CRP were observed. EAA, Endotoxin Activity Assay; PC, procalcitonin; CRP, C reactive protein; PVPI, Pulmonary Vascular Permeability Index.

• 

  Fig. 3 Relationship between EAA and PiCCO data. The PVPI values were significantly higher in the EAA-A at 3.55±0.48 in comparison with EAA-N at 1.99±0.68 (p=0.0029). There was a tendency that EAA-A has higher PVPI values than EAA-N. EAA, Endotoxin Activity Assay; PiCCO, Pulse Contour Cardiac Output; PVPI, Pulmonary Vascular Permeability Index.

• 

  Fig. 4 Relationship between PC and PiCCO data. The PC values didn't significantly correlate with either EVLW or PVPI. PC, procalcitonin; PiCCO, Pulse Contour Cardiac Output; PVPI, Pulmonary Vascular Permeability Index; EVLW, Extra Vascular Lung Water.

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