Evidence map›Paper›PMID 40875608›Full record

Observational studyCritical care explorations2025

Organ Failure, Endotoxin Activity, and Mortality in Septic Shock.

Luca Molinari, Mark A Tidswell, Ali Al-Khafaji, Danielle Davison, Claude Galphin, Esha Kamaluddin, Debra M Foster, John A Kellum

Abstract readObservational StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Critical care explorations, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Review
  2. Article
  3. Review
  4. Article
  5. Review
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Luca MolinariDepartment of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy.
Mark A TidswellDivision of Pulmonary and Critical Care Medicine, Baystate Medical Center, Springfield, MA.
Ali Al-KhafajiDepartment of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
Danielle DavisonDivision of Critical Care Medicine, The George Washington University, Washington DC.
Claude GalphinSoutheast Renal Research Institute, CHI Memorial Hospital, Chattanooga, TN.
Esha KamaluddinSpectral Medical, Toronto, ON, Canada.
Debra M FosterSpectral Medical, Toronto, ON, Canada.
John A KellumDepartment of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.ORCID 0000-0003-1995-2653

Funding

Spectral Medical
6 · The paper itself

Abstract

importanceThe relationship between endotoxin activity, organ failure, and mortality is not well understood.

objectiveTo test whether the combination of endotoxin activity and organ failure identifies patients at higher risk of death from sepsis and determine the relationship to previously described sepsis phenotypes. DESIGN, SETTING, AND

participantsProspective observational study in four ICUs enrolling critically ill patients with septic shock. MAIN OUTCOMES AND MEASURES: Endotoxin activity assay (EAA) results, Sequential Organ Failure Assessment (SOFA), and multiple organ dysfunction (MODS) and 28-day mortality.

resultsWe enrolled 90 patients aged 25-95 years and set an EAA cutoff of greater than or equal to 0.6 together with SOFA greater than 11 or MODS greater than 9 to define endotoxic septic shock (ESS). At baseline mean EAA was 0.64 (sd = 0.19), whereas mean SOFA and MODS were 10.3 (sd 3.2) and 5.8 (sd 3.1), respectively. EAA greater than or equal to 0.6 and SOFA greater than 11 were present in 20 patients (23.3%) and these patients had 60% mortality. EAA greater than or equal to 0.6 and SOFA less than or equal to 11 occurred in 31 (36.0%) with mortality 12.9%. Of the 35 remaining patients with EAA less than 0.6, 29 (33.7%) had SOFA less than or equal to 11 and 5 of them (17.2%) died. Only six patients (7.0%) had EAA less than 0.6 and SOFA greater than 11 and none died (p < 0.001). All patients with MODS greater than 9 also had EAA greater than or equal to 0.6 (12 patients) with 75% mortality. EAA greater than or equal to 0.6 with MODS less than or equal to 9 occurred in 39 patients with 17.9% mortality (p < 0.001). ESS (EAA ≥ 0.6 together with SOFA > 11 or MODS > 9) occurred in 21 patients and they had significantly higher mortality (57.1% vs. 15.9%, p < 0.001) compared with non-ESS, with a relative risk for death of 3.58 (95% CI, 1.86-6.91). Among ESS patients, 7 (33.3%) had δ phenotype, whereas only 4 (5.8%) had δ among non-ESS (p = 0.001). CONCLUSIONS AND RELEVANCE: ESS compromises patients with the highest mortality rate from sepsis. Such patients are most appropriate for trials testing anti-endotoxin therapy for improving survival.

Indexed as

EndotoxinsMultiple Organ FailureShock, SepticAdultAgedAged, 80 and overFemaleHumansIntensive Care UnitsMaleMiddle AgedOrgan Dysfunction ScoresProspective StudiesEndotoxinsendotoxinmultiple organ failurepolymyxin Bsepsisseptic shock

Identifiers

PMID40875608
PMCPMC12398369

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.