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Abstract: PO0203

Circulating Endotoxin Levels Correlate with Kidney and Mortality Outcomes in Critically Ill Patients

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention


  • Kim, Chang Kyung, Stony Brook University, Stony Brook, New York, United States
  • Khan, Sobia N., Stony Brook University, Stony Brook, New York, United States
  • Fairuz, Fabliha, Stony Brook University, Stony Brook, New York, United States
  • Mallipattu, Sandeep K., Stony Brook University, Stony Brook, New York, United States
  • Piret, Sian, Stony Brook University, Stony Brook, New York, United States

Among the critically ill, sepsis is a common cause of acute kidney injury (AKI). Endotoxin is a component of gram negative bacterial cell walls, and is a potent trigger of AKI in sepsis, but may also be present in non-bacteremic patients. Our aim was to determine correlations between endotoxin levels and AKI and mortality outcomes in incident critically ill patients.


Patients were recruited from those admitted to intensive care units (ICUs) who were over 18, and who did not have end-stage renal failure requiring dialysis, or were on chronic immunosuppressive medications. Blood endotoxin activity (EA) was measured using the FDA-approved chemiluminescent EA Assay. Blood EA was measured on days 1, 4 and 8 of admission to ICU, and results either categorized as low (0.0-0.39), intermediate (0.4-0.59) or high (≥0.60), or used as a continuous variable in Spearman correlation analysis. Kidney parameters and dispositions were obtained from electronic medical records. AKI was defined as per KDIGO guidelines.


A total of 35 patients were recruited between November 2020 and April 2021, with 4 testing positive for gram negative bacteria. Initial EA levels were 6 (17%), 10 (29%) and 19 (54%) patients with low, intermediate, and high levels, respectively. During the study, 14 patients’ EA levels changed such that their categorization either went up (4) or down (9), whilst one patient alternated between intermediate and high levels. When stratified by presence of AKI, no patients with low EA (0/6) developed AKI, whilst 9/13 (71%) of patients with AKI had high EA versus 8/20 (40%) of non-AKI patients who had high EA. All of the patients with low EA were discharged, whereas 3/10 (30%) and 4/18 (22%), respectively, of those with intermediate and high EA expired. When analyzed as a continuous variable, there was a significant positive correlation between initial EA and initial sCr (r = 0.56, p<0.001). Furthermore, there was a significant correlation between the rates of changes in EA and sCr over time (r = 0.47, p<0.05).


Endotoxin levels on admission to ICU correlated with kidney function, presence of AKI, and mortality. Changes in EA over time also correlated with changes in kidney function, suggesting that EA may be a potential biomarker in critically ill patients.


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