Endotoxin is a Promising Biomarker for Identifying Culture-Positive Cases of Sepsis
Author(s): Nazia Mahjabeen, Ahmed Abu Saleh, AKM Akhtaruzzaman, SM Ali Ahmed, Shaila Akhtar, Shaheda Anwar
Background: Sepsis is a dysregulated systemic reaction to infection. Although blood culture is considered as the gold standard, it does not qualify as a single method for diagnosing sepsis. Biomarkers likeendotoxin and C-reactive protein (CRP) levels have the potential to diagnose infections quickly.
Objective: This study aimed to evaluate the endotoxin activity and CRP level for the diagnosis of sepsis.
Methods: This cross-sectional study was conducted at the Department of Microbiology and Immunology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Demographic profiles, clinical features, history of antibiotic intake, invasive procedures, and laboratory parameters of the enrolled participants were collected. Sepsis was leveled by quick sequential organ failure assessment (qSOFA) scores. A blood culture was done following standard procedure. Serum CRP level was measured by immuno-nephelometry and kinetic ELISA methods to estimate serum endotoxin level. Data were analyzed and compared by statistical tests.
Result: 50 participants were enrolled. Their mean age was 58.92±18.22 years; the majority belonged to 61-70 years, and males were predominant (58%). Of them, 18 (36%) had detected blood culture positive, where Acinetobacter species was predominant (27.77%), followed by Escherichia coli (16.67%) and Ochrobactrum anthropi (16.67%). Out of 50 study populations, 48 (96%) cases had a serum level of CRP >10 mg/L, while a serum level of endotoxin >0.5 EU/mL was observed in 17 (34.0%) cases. A significant difference was observed in the endotoxin level between culture-positive and culture-negative groups (p<0.001). The receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) was 0.88 for endotoxin, and that was significant (p<0.05). CRP had a significant positive correlation with qSOFA (r= 0.305; p= 0.032).
Conclusion: Endotoxin is a promising biomarker for identifying culturepositive cases of sepsis. C-reactive protein (CRP) level is positively correlated with qSOFA score.