Can sepsis be better defined? Contribution of a novel assay for endotoxin

Sepsis is the leading killer of ICU patients and the 11th leading cause of death overall. One of the greatest challenges in sepsis is rapidly and accurately identifying patients who have it. Establishing an infectious component of sepsis rather than a non-infective cause of the systemic inflammatory response syndrome can be extremely difficult. Endotoxin is a known potent trigger of the sepsis cascade. Using the Endotoxin Activity Assay (Spectral Diagnostics, Toronto, Ontario, Canada) for endotoxin measurement, we report findings from an observational clinical trial exploring endotoxin levels, infection status, and sepsis in ICU patients. Microbiologically proven infection was relatively uncommon in this group of patients, as in other series, despite the fact that many met criteria for sepsis. Moreover, the results are available long after physicians need the information. As such, the inclusion of infection in the definition of sepsis should be revisited. Endotoxemia may be a more clinically relevant marker of sepsis.