The Influence of Plasma Endotoxin Concentration on the Clinical Course of Gastroenterological Surgical Diseases

Hidetaka Mochizuki, Kazuyoshi Yoshimura, Tsukasa Yoshizumi, Eiji Takeuchi, Minoru Kakihara, Shoetsu Tamakuma

The First Department of Surgery, National Defense Medical College

The condition of plasma endotoxin concentration, determined by Toxicolor Test ^® (LCT), of more than 50 pg/ml is defined as hyperendotoxemia. Sixty-one patients were given a diagnosis of hyperendotoxemia during an investigation period of 4 years and 5 months. Of these patients, 43 had septic foci (41 had gram-negative rod infections and 2 had fungal infections), 9 had no evidence of infectious foci but severe hepatic damage, and the other 9 had a severely advanced malignant tumor with slight infection such as respiratory or urinary tract infection. Septic hyperendotoxemic patients showed significantly higher rates of shock, vital organ damage and mortality than septic patients without hyperendotoxemia (p<0.01). Septic hyperendotoxemic patiens wiht shock and those who died showed significantly higher plasma endotoxin concentrations than those without shock and those who survived. (p<0.03). It is suggested that plasma endotoxin of septic patients has a significant influence on the clinical course and that endotoxin concentration determined by LCT has a significant meaning for the estimation of septic patients' prognosis. It is speculated that hyperendotoxemia with a severely advanced malignant tumor might have some influence on the emaciation of those patients through the production of cachectin from macrophages. On the other hand, highly concentrated plasma endotoxin in patients with fungal infection or severe hepatic damage seemed to have no relation to the clinical course. Considering the non-specific factors present in the lysate of LCT and activated by non-specific substances such as β-glucan, it is suggested that the results detemined by LCT in such patients might not reflect the exact plasma endotoxin concentration.

Key words
plasma endotoxin concentration, hyperendotoxemia, sepsis, gram-negative rod infection

Reprint requests
Hidetaka Mochizuki The First Department of Surgery, National Defense Medical Colege
3-2 Namiki, Tokorozawa, 359 JAPAN

Accepted
November 8, 1989

To read the PDF file you will need Abobe Reader installed on your computer.