Toxic shock syndrome toxin 1(TSST-1) and endotoxin levels in patients with severe sepsis.

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The plasma TSST-1 and endotoxin levels were measured in 54 samples from 41 septic patients. The plasma TSST-1 levels were measured by ELISA. "TSST-1 positive" was defined as more than 100pg/ml in plasma. The plasma endotoxin levels were measured by the chromogenic Limulus test. "Endotoxin positive" was defined as more than 9.8pg/ml in plasma. All patients received direct hemoperfusion with polymixin B-immobilized fiber (PMX) that removes endotoxin from the blood. Mortality was evaluated at 2 weeks after direct hemoperfusion. Forty-six samples (85.2%) were endotoxin positive. Thirty-five samples (64.8%) were TSST-1 positive. Thirty-two samples were both endotoxin and TSST-1 positive. Five samples were both TSST-1 and endotoxin negative. TSST-1 levels in the endotoxin positive group were significantly higher than those in the endotoxin negative group (250.5±406.3 vs 67.7±72.4pg/ml, mean+SD, p<0.05). There is no difference in endotoxin and TSST-1 levels between survivors and non-survivors. The septic severity score and number of failing organs in the non-survivor group are significantly higher than those in the survivor group. TSST-1 prolonged endotoxin clearance from the blood. In severe sepsis, it is believed that polymicrobial infections are frequently complications and caused the poor prognosis.
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