Plasma Endotoxin as a Predictor of Multiple Organ Failure and Death in Systemic Meningococcal Disease

We studied prospectively the quantitative relation of circulating endotoxin (lipooligosaccharides [LOSs)) and the development of multiple organ failure and death in 45 consecutively admitted patients with bacteriologically verified systemic meningococcal disease (SMD). A plasma illS level of >700 ng/L correlated with development of severe septic shock (P .0001), adult respiratory distress syndrome (P = .(035), a pathologically elevated serum creatinine level (P < .0001), or death as a consequence of multiple organ failure (P = .0002). Initial plasma illS levels of 10 000 ng/L were associated with 0%, 14%, 27%, and 86% fatality, respectively. The illS half-life after initiation of antibiotic therapy was 1–3 h. Increasing plasma LOS levels were never seen. These observations suggest that LOS quantitation using the limulus amebocyte lysate assay with a chromogenic substrate gives important progsnotic information and may provide new insight concerning pathophysiological aspects of SMD.