@article{3165551,
    title = "Endotoxemia as a Diagnostic Tool for Patients with Suspected Bacteremia
Caused by Gram-Negative Organisms: a Meta-Analysis of 4 Decades of
Studies",
    author = "Hurley, James C. and Nowak, Piotr and Ohrmalm, Lars and Gogos, and Charalambos and Armaganidis, Apostolos and Giamarellos-Bourboulis, and Evangelos J.",
    journal = "Journal of Clinical Microbiology",
    year = "2015",
    volume = "53",
    number = "4",
    pages = "1183-1191",
    publisher = "AMER SOC MICROBIOLOGY",
    issn = "0095-1137, 1098-660X",
    doi = "10.1128/JCM.03531-14",
    abstract = "The clinical significance of endotoxin detection in blood has been
evaluated for a broad range of patient groups in over 40 studies
published over 4 decades. The influences of Gram-negative (GN)
bacteremia species type and patient inclusion criteria on endotoxemia
detection rates in published studies remain unclear. Studies were
identified after a literature search and manual reviews of article
bibliographies, together with a direct approach to authors of
potentially eligible studies for data clarifications. The concordance
between GN bacteremia and endotoxemia expressed as the summary
diagnostic odds ratios (DORs) was derived for three GN bacteremia
categories across eligible studies by using a hierarchical summary
receiver operating characteristic (HSROC) method. Forty-two studies met
broad inclusion criteria, with between 2 and 173 GN bacteremias in each
study. Among all 42 studies, the DORs (95% confidence interval) were
3.2 (1.7 to 6.0) and 5.8 (2.4 to 13.7) in association with GN
bacteremias with Escherichia coli and those with Pseudomonas aeruginosa,
respectively. Among 12 studies of patients with sepsis, the proportion
of endotoxemia positivity (95% confidence interval) among patients with
P. aeruginosa bacteremia (69% [ 57 to 79%]; P = 0.004) or with
Proteus bacteremia (76% [ 51 to 91%]; P = 0.04) was significantly
higher than that among patients without GN bacteremia (49% [ 33 to
64%]), but this was not so for patients bacteremic with E. coli (57%
[ 40 to 73%]; P = 0.55). Among studies of the sepsis patient group,
the concordance of endotoxemia with GN bacteremia was surprisingly weak,
especially for E. coli GN bacteremia."
}