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Gram-Negative Sepsis: Detection of Endotoxemia with the Limulus Test: With Studies of Associated Changes in Blood Coagulation, Serum Lipids, and Complement

JACK LEVIN, M.D., F.A.C.P.; T. EDWIN POORE, M.D.; NEAL S. YOUNG, M.D.; SIMEON MARGOLIS, M.D.; NEIL P. ZAUBER, M.D.; ALEXANDER S. TOWNES, M.D., F.A.C.P.; and WILLIAM R. BELL, M.D.
[+] Article and Author Information

Dr. Levin is a John and Mary Markle Scholar in Academic Medicine, The John and Mary R. Markle Foundation, New York, N.Y.; and recipient of Research Career Development Award 1KO4HE29906, from the National Heart and Lung Institute, National Institutes of Health, Bethesda, Md.

▸Requests for reprints should be addressed to Jack Levin, M.D., Division of Hematology, The Johns Hopkins Hospital, 601 N. Broadway, Baltimore, Md. 21205


Baltimore, Maryland


Ann Intern Med. 1972;76(1):1-7. doi:10.7326/0003-4819-76-1-1
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Two hundred and eighty-one patients suspected of having Gram-negative sepsis were studied. Fifty (18%) had Gram-negative sepsis, that is endotoxemia or bacteremia, or both. Endotoxemia was found in 14%. A blood culture positive for Gram-negative organisms was found in 12%, and endotoxemia and bacteremia occurred together in 7%. The Limulus test was positive only in patients with Gram-negative infections, many of whom had bacteremia. Hypotension and death occurred twice as frequently in patients with demonstrable endotoxemia as in patients with only Gram-negative bacteremia. Fourteen percent of patients with Gram-negative sepsis had hypofibrinogenemia, and almost all had elevated levels of fibrinogen degradation products in their serum. Serum triglycerides were elevated in 35% of patients with sepsis, but only two had marked elevations of free fatty acids. Four of eight patients with sepsis had reduced complement levels. The Limulus test can be used prognostically to define a population with a high mortality.

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