Please use this identifier to cite or link to this item: http://hdl.handle.net/11054/53
Title: Endotoxemia and mortality prediction in ICU and other settings: underlying risk and co-detection of gram negative bacteremia are confounders.
Authors: Hurley, James C.
Guidet, Bertrand
Offenstadt, Georges
Maury, Eric
Issue Date: 2012
Publisher: BioMed Central Ltd
Place of publication: London
Publication Title: Critcal Care
Volume: 16
Issue: 4
Start Page: R148
Abstract: ABSTRACT: INTRODUCTION: The interdependence between endotoxemia, gram negative (GN) bacteremia and mortality has been extensively studied. Underlying patient risk and GN bacteremia types are possible confounders of the relationship. METHODS: Published studies with ≥10 patients in either ICU or non-ICU settings, endotoxemia detection by limulus assay, reporting mortality proportions and ≥1 GN bacteremia were included. Summary odds ratios (OR) for mortality were derived across all studies by meta-analysis for the following contrasts: sub-groups with either endotoxemia (group three), GN bacteremia (group two) or both (group one) each versus the group with neither detected (group four; reference group). The mortality proportion for group four is the proxy measure of study level risk within L'Abbé plots. RESULTS: Thirty-five studies were found. Among nine studies in an ICU setting, the OR for mortality was borderline (OR <2) or non-significantly increased for groups two (GN bacteremia alone) and three (endotoxemia alone) and patient group one (GN bacteremia and endotoxemia co-detected) each versus patient group four (neither endotoxemia nor GN bacteremia detected). The ORs were markedly higher for group one versus group four (OR 6.9; 95% confidence interval (CI), 4.4 -to 11.0 when derived from non-ICU studies. The distributions of Pseudomonas aeruginosa and Escherichia coli bacteremias among groups one versus two are significantly unequal. CONCLUSIONS: The co-detection of GN bacteremia and endotoxemia is predictive of increased mortality risk versus the detection of neither but only in studies undertaken in a non-ICU setting. Variation in GN bacteremia species types and underlying risk are likely unrecognized confounders in the individual studies.
URI: http://hdl.handle.net/11054/53
ISSN: 1364-8535
Internal ID Number: 00039
Health Subject: GRAM NEGATIVE BACTEREMIA
ENDOTOXEMIA
ODDS RATIO
META ANALYSIS
L’ABBE PLOTS
Type: Journal Article
Article
Appears in Collections:Research Output

Files in This Item:
File Description SizeFormat 
00039.pdf520.53 kBAdobe PDFThumbnail
View/Open


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.