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Abstract: FR-PO087

Circulating Endotoxin and Inflammatory Proteins Correlate With Kidney and Hospitalization Outcomes in Critically Ill Patients

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention


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

Endotoxin, a component of gram negative bacterial cell walls, may be present in the circulation of critically ill patients with or without bacteremia, and is a potent trigger of AKI and inflammation. Our aim was to determine correlations between endotoxin levels, inflammatory proteins, and AKI and hospitalization outcomes in incident critically ill patients.


Patients were recruited from those aged 18 or over admitted to intensive care units (ICUs), who did not have end-stage renal failure requiring dialysis, or were on chronic immunosuppressive medication. Blood endotoxin levels were measured within 48 hours of ICU admission using the FDA-approved endotoxin activity assay (EAA). EAA results were categorized as either low/intermediate (<0.6) or high (≥0.6), or used as a continuous variable. Kidney parameters, vital signs, and dispositions were obtained from electronic medical records. AKI was defined as per KDIGO guidelines. Plasma proteomics was undertaken on 87 patients using the O-link Target 96 inflammation panel.


A total of 106 patients were recruited between November 2020 and March 2022, with 4 patients testing positive for gram negative bacteria. EAA levels were <0.6 in 54 patients (51%) and ≥0.6 in 52 patients (49%). There was a positive correlation between EAA and serum creatinine levels (p<0.05). Only 2/54 patients (3.7%) with EAA <0.6 developed AKI stage III versus 9/52 patients (17.3%) with EAA ≥0.6 (p<0.05). Combined EAA plus SOFA score was significantly higher in patients with AKI versus no AKI (p<0.0001). Patients with EAA ≥0.6 has a significantly longer hospital stay than patients with EAA <0.6 (p<0.05). Hierarchical clustering analysis using plasma proteomics data resulted in two clusters, with most of the patients without AKI represented in a separate cluster from those with AKI. Analysis of individual protein levels between the two clusters showed differences in levels of IL8, MCP-3, FGF23, IL-10, and CCL20. These proteins were also significantly higher when compared specifically in patients with AKI versus no AKI (p<0.01 – p<0.0001).


Endotoxin levels on admission to ICU correlated with kidney function and AKI, and patients with high EAA had longer hospital stay. Patients with AKI also had higher levels of specific circulating inflammatory proteins.