%0 Journal Article %T Endotoxemia and mortality prediction in ICU and other settings: underlying risk and co-detection of gram negative bacteremia are confounders. %+ Rural Health Academic Centre %+ Division of Internal Medicine %+ CHU Saint-Antoine [AP-HP] %+ Epidémiologie des maladies infectieuses et modélisation (ESIM) %A Hurley, James %A Guidet, Bertrand %A Offenstadt, Georges %A Maury, Eric %< avec comité de lecture %@ 1364-8535 %J Critical Care %I BioMed Central %V 16 %N 4 %P R148 %8 2012-08-07 %D 2012 %R 10.1186/cc11462 %M 22871090 %Z Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO]Journal articles %X ABSTRACT: INTRODUCTION: The interdependence between endotoxemia, gram negative (GN) bacteremia and mortality has been extensively studied. Underlying patient risk and GN bacteremia types are possible confounders of the relationship. METHODS: Published studies with [greater than or equal to]10 patients in either ICU or non-ICU settings, endotoxemia detection by limulus assay, reporting mortality proportions and [greater than or equal to]1 GN bacteremia were included. Summary odds ratios (OR) for mortality were derived across all studies by meta-analysis for the following contrasts; sub-groups with either endotoxemia (group 3), GN bacteremia (group 2) or both (group 1) each versus the group with neither detected (group 4; reference group). The mortality proportion for group 4 is the proxy measure of study level risk within L'Abbe plots. RESULTS: 35 studies were found. Among 9 studies in an ICU setting, OR for mortality was borderline (OR < 2) or non-significantly increased for groups 2 (GN bacteremia alone) and 3 (endotoxemia alone) and patient group 1 (GN bacteremia and endotoxemia co-detected) each versus patient group 4 (neither endotoxemia nor GN bacteremia detected). The OR's were markedly higher for group 1 versus group 4 (OR 6.9; 95% CI, 4.4 - 11.0 when derived from non-ICU studies. The distributions of P aeruginosa and E coli bacteremias among groups 1 versus 2 are significantly unequal. CONCLUSIONS: The co-detection of GN bacteremia and endotoxemia is predictive of increased mortality risk versus the detection of neither but only in studies undertaken in a non-ICU setting. Variation in GN bacteremia species types and underlying risk are likely unrecognized confounders in the individual studies. %G English %2 https://inserm.hal.science/inserm-00731506/document %2 https://inserm.hal.science/inserm-00731506/file/cc11462.pdf %L inserm-00731506 %U https://inserm.hal.science/inserm-00731506 %~ INSERM %~ UPMC %~ APHP %~ SORBONNE-UNIVERSITE %~ SU-INF-2018 %~ SU-MEDECINE %~ SU-MED %~ SU-TI %~ ALLIANCE-SU