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

J Infect Dis. 1989 Feb;159(2):195-204. doi: 10.1093/infdis/159.2.195.


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 LOS level of greater than 700 ng/L correlated with development of severe septic shock (P less than .0001), adult respiratory distress syndrome (P = .0035), a pathologically elevated serum creatinine level (P less than .0001), or death as a consequence of multiple organ failure (P = .0002). Initial plasma LOS levels of less than 25, 25-700, 700-10,000, and greater than 10,000 ng/L were associated with 0%, 14%, 27%, and 86% fatality, respectively. The LOS 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.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Endotoxins / blood*
  • Female
  • Humans
  • Infant
  • Lipopolysaccharides / blood*
  • Male
  • Meningitis, Meningococcal / blood
  • Meningitis, Meningococcal / complications*
  • Meningitis, Meningococcal / mortality
  • Multiple Organ Failure / physiopathology*
  • Neisseria meningitidis / isolation & purification
  • Prognosis
  • Shock, Septic / blood*
  • Shock, Septic / complications
  • Shock, Septic / mortality


  • Endotoxins
  • Lipopolysaccharides
  • lipid-linked oligosaccharides