Abstract
Patients with suspected septicemia were screened for endotoxemia with a quantitative chromogenic assay. In some patients endotoxin concentrations were within the range of healthy controls. Eleven of these were patients on intensive care with severe, culture-verified, gram-negative infections in blood or other foci. One possible explanation for this paradoxical absence of endotoxin is increased plasma inactivation. In order to test this hypothesis, endotoxin was added to platelet-rich plasma from these patients to give a concentration of 100 ng/l, and serial quantitative determinations were made for 2 hours. Plasma from 11 healthy individuals served as controls. In the first sample, measured immediately after addition of endotoxin, a mean of 97.3 ng/l was recovered in plasma from healthy individuals and only 75.8 ng/l in the septic plasma ( p<0.05). When kept on ice, these concentrations were maintained, while at +37‡C they decreased rapidly at rates that were equal in both septic and control plasmas. In a corresponding study in platelet-free plasma, it was found that the platelets could not account for this inactivation. The results demonstrate the possibility of immediate endotoxin inactivation in plasma from patients with sepsis, probably caused by chemical binding.
Résumé
Des malades suspects d'Être atteints de septicémie ont été soumis à un dosage chromogénique quantitatif de l'endotoxine circulante. Chez quelques uns d'entre eux les concentrations de l'endotoxine étaient voisines de celles des sujets sains. Onze de ces sujets étaient soumis à des soins intensifs alors qu'ils présentaient une infection grave vérifiée par culture: infection sanguine ou foyers divers à gram négatif. Cette absence paradoxale d'endotoxine s'expliquerait par l'augmentation de l'inactivation plasmatique. Dans le but de vérifier cette hypothèse une endotoxine fut ajoutée au plasma riche en plaquettes de ces malades de manière à obtenir une concentration de 10 ng/l, et des dosages en série furent pratiqués toutes les 2 heures. Le plasma de 11 sujets sains fut étudié à tire de contrÔle. Dans le premier échantillon dosé immédiatement après l'adjonction d'endotoxine une moyenne de 97.3 ng/l fut constatée dans le plasma des sujets sains et seulement de 75.8 ng/l dans le plasma des sujets infectés (p < 0.05) les concentrations restant égales sous conservation glacée alors qu'elles décrurent rapidement à 37 degrés aussi bien dans le plasma des sujets infectés que dans celui des sujets sains. Dans une étude correspondante concernant le plasma sans plaquettes il a été constaté que les plaquettes ne peuvent expliquer cette inactivation de l'endotoxine. Il en résulte que celle-ci doit Être le fait d'un facteur chimique.
Resumen
Pacientes con sospecha de septicemia fueron investigados para establecer la presencia de endotoxemia mediante análisis cromogénicos cuantitativos. En algunos casos las concentraciones de endotoxina se encontraron dentro del rango de los individuos normales utilizados como control. Once de estos eran pacientes en unidades de cuidado intensivo con severas infecciones gram-negativas, verificadas por cultivo, en la sangre o en otros focos. Una posible explicación para esta ausencia paradójica de endotoxina es una aumentada inactivación plasmática. Con el objeto de probar esta hipótesis, se añadió endotoxina al plasma rico en plaquetas obtenido de estos pacientes para lograr una concentración de 100 ng/l, y se hicieron determinaciones cuantitativas seriadas por periodos de 2 horas. El plasma de once individuos normales sirvió como control. En la primera muestra, medida inmediatamente después de la adición de endotoxina, se encontró un promedio de 97.3 ng/l en el plasma de los individuos normales y de solo 75.8 ng/l en el plasma séptico (p < 0.05). Si el plasma se mantuvo en hielo, estas concentraciones se mantuvieron constantes, en tanto que a +37‡C disminuyeron rápidamente, y las ratas de disminución fueron iguales tanto para los plasmas sépticos como para los de control. En un estudio correspondiente en plasma libre de plaquetas se encontró que las plaquetas no podrían ser inculpadas de esta inactivación. Los resultados demuestran la posibilidad de una inactivación inmediata de la endotoxina en el plasma de pacientes sépticos, probablemente causada por ligación química.
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Olofsson, P., Olofsson, C., Nylander, G. et al. Endotoxin inactivation in plasma from septic patients: An in vitro study. World J. Surg. 10, 318–322 (1986). https://doi.org/10.1007/BF01658154
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DOI: https://doi.org/10.1007/BF01658154