1. 
    

   	Endotoxemia and Endotoxin Shock: Disease, Diagnosis and Therapy Editors: Claudio Ronco, Vicenza, Pasquale Piccinni, Vicenza, Mitchell H. Rosner, Charlottesville, VA Contributions to Nephrology,  Vol. 167 Available from Karger Publishing

2. Prevalence of endotoxemia after surgery and its association
   with ICU length of stay
   Franco Valenza, Lorella Fagnani, Silvia Coppola, Sara Froio, Francesca Sacconi, Cecilia Tedesco, Micol Maffioletti, Marta Pizzocri, Valentina Salice, Maria LUISA Ranzi, Cristina Marenghi and Luciano Gattinoni
   Critical Care 2009, 13:R102, June 2009
    

3. Early Use of Polymyxin B Hemoperfusion in Abdominal Septic Shock
   The EUPHAS Randomized Controlled Trial
   Dinna N. Cruz, MD, MPH; Massimo Antonelli, MD; Roberto Fumagalli, MD; Francesca Foltran, MD; Nicola Brienza, MD, PhD; Abele Donati, MD; Vincenzo Malcangi, MD; Flavia Petrini, MD; Giada Volta, MD; Franco M. Bobbio Pallavicini, MD; Federica Rottoli, MD; Francesco Giunta, MD; Claudio Ronco, MD
   JAMA. 2009;301(23):2445-2452. June 2009
    

4. Endotoxemia is common following abdominal organ transplantation
   and is associated with reperfusion and rejection.
   Ibtesam Hilmi, John A. Kellum, Raymond Planinsic, Debra Foster, Ali Abdullah, Daniela Damian, Silviu Gligor, David Klein, Kareem Abu-Elmagd.
   Journal of Organ Dysfunction, March 2009.
    

5. Newly Developed Endotoxin Measurement Method (Endotoxin Activity Assay) May Reflect the Severity of Sepsis.

   Murayama, Y Kakihana, T Oryoji, N Kiyonaga, S Tashiro, T Imabayashi, T Yasuda and Y Kanmura, Kagoshima University Hospital, Kagoshima, Japan

   Poster Presentation From 29th International Symposium on Intensive Care and Emergency Medicine, Brussels, Belgium. 24–27 March 2009
    

6. Endotoxemia as a Biomarker in Early Sepsis:
   Experience from Europe and North America.
   Foster, Debra; Abstract - 11^th Annual Congress of Endotoxemia in Critical Illness, Fukouka, Japan, February, 2008
    

7. Clinical Usefulness of a Newly Developed Whole Blood Endotoxin Assay (EAA).
   Atagi Kazuaki, Shimaoka Hideki, and Nishi Shinichi
   ICU and CCU-Japanese Journal of Intensive Care Medicine, Vol. 31, No. 6, 445-452, 2007. 
    

8. Efficacy and Problem of a New Endotoxin Activity Assay Method.
   Endo Shigeatsu, Sato Nobuhiro, Suzuki Yasushi, Kojika Masahiro, Takahashi Gaku, Yaegashi Yasunori
   ICU and CCU-Japanese Journal of Intensive Care Medicine, Vol. 31, No. 6, 407-410, 2007
    

9. Diagnostic and Prognostic Implications Endotoxemia Based on
   Measurements Using the Endotoxin Activity Assay.
   Walker Paul M., Japanese J. of Critical Care Endotoxemia, Vol. 11, No.1, 9-25,  2007
    

10. Endotoxemia: Insights from a New Method for Measurement in
    Human Whole Blood.
    Foster Debra M., Japanese J. of Critical Care Endotoxemia, Vol. 11, No.1, 121-126, 2007.
     

11. Patients with Chronic Kidney Disease (CKD) stage 3-5 have
    Endotoxin levels similar with ICU patients with sepsis.
    Levine Daniel, Parker Thomas, Bologa Roxana, Gordon Bruce, Foster Debra, Walker Paul, Klein David
    Abstract - ASN Renal Week 2007, San Francisco, CA
     

12. Daily Variation in Endotoxin Levels is Associated with Increased
    Organ Failure in Critically Ill Patients.
    Klein DJ, Derzko A, Foster D, Seely A, Brunet F, Romaschin A, Marshall JC.,
    Shock, November 2007
     

13. Endotoxin Levels as a Marker for Liver Graft Performance in
    Patients Undergoing Liver Transplantation.
    Hilmi, RM Planinsic, Daniela Damian, Testsuro Sakai, Nizar Moayeri
    Abstract Presented at ASA Annual Meeting, San Francisco California, Oct. 2007
     

14. Endotoxin Concentration Following Cardiac Surgery with
    Cardiopulmonary Bypass.
    Kagoshima University ICU,
    Abstract Presented at ASA Annual Meeting, San Francisco California, October, 2007
     

15. Endotoxin activity in whole blood measured by neutrophil
    chemiluminescence is applicable to canine whole blood.
    Mads Kjelgaard-Hansen, Bo Wiinberg, Bent Aalbæk, Lisbeth Olsen, David Harris, Alexander Romaschin, Annemarie T. Kristensen and Asger L. Jensen
    Comparative Immunology, Microbiology and Infectious Diseases, August 2007

16. Endotoxemia in pediatric critical illness.
    S. Nadel, 5^th World Congress on Pediatric Critical Care, Geneva Switzerland, June, 2007
     

17. Prevalence of Endotoxemia in a population of patients admitted
    to an intensive care unit after elective surgery.
    F. Valenza, L. Fagnani, S. Coppola, L. Gattinoni  et al, 
    27^th International Symposium on Intensive Care and Emergency Medicine, Critical Care, Vol 11 Suppl2, March 2007
     

18. Patterns of Endotoxemia in a Paradigm of Early Goal Directed Therapy
    Ronny M. Otero, Arturo Suarez, Steadman S. Sankey and Emanuel Rivers,
    26^th annual meeting of the Society of Critical Care Medicine, Orlando, FL February 2007
     

19. Hemodialysis patients have Endotoxin activity levels comparable
    to critically ill patients.
    Bologa, Roxana M. Levine, Daniel M. Parker, Thomas S. Gordon, Bruce R. Foster, Debra  Walker, Paul  Klein, David J., 25^th annual meeting of the Society for Critical Care Medicine, January 6, 2006, San Francisco, CA
     

20. Endotoxemia is a marker of adverse outcomes in patients with Gram positive as well as Gram negative infection on admission to the Intensive Care Unit.
    David J Klein, Debra Foster, Anastasia Derzko, John C Marshall, Toronto Critical Care Medicine Meeting, October 30, 2005.
     

21. A comparison of the rates of agreement for assays of endotoxin (EAA) procalcitonin (PCT) and lactate in septic and non-septic critically ill patients. 
    Alex Romaschin, Anastasia Derzko, Debra Foster, David Klein, Paul Walker:
    from 25th International Symposium of Intensive Care and Emergency Medicine, Brussels Belgium, March 22-25, 2005.
     

22. Marker or Mediator: Changes in endotoxin activity as a predictor of adverse outcomes in critical illness.
    Klein DJ, Derzko A, Seely A, Foster D and Marshall JC
    from 25th International Symposium on Intensive Care and Emergency Medicine
    Brussels, Belgium. 21–25 March 2005
     

23. A Comparison of the rates of agreement for assays of Endotoxin, procalcitonin and lactate in septic and non-septic critically ill patients.
    A. Romaschin, J. Marshall, D. Klein. D. Foster, American Association of Clinical Chemists, Los Angeles, California.  July 2005.

24. A Novel Method for rapid detection of human endotoxemia.
    Foster DM, Derzko AN & Romaschin AD. Clinical Laboratory International, April 2004.

25. Diagnostic and Prognostic Implications of Endotoxemia in Critical Illness: Results of the MEDIC Study.
    JC Marshall, D Foster, JL Vincent, DJ Cook, et al., Journal of Infectious Diseases, Aug. 2004. 

26. Can Sepsis be better defined? Contribution of a novel assay for endotoxin.
    Foster DM, Derzko AN & Keffer JH. Clinical Microbiology Newsletter 26: 3, 2004

27. Measurement of endotoxin activity in critically ill patients using whole blood neutrophil dependent chemiluminescence.
    Marshall JC, Walker PM, Foster DM, et al. Critical Care 2002; 6(4): 342-348

28. A rapid assay of endotoxin in whole blood using autologous neutrophil dependent chemiluminescence.
    Romaschin AD, Harris DM, Ribeiro MB, et al., J. Immunol. Methods 1998; 212: 169-185.

29. Let the Cells Speak: neutrophils as biologic markers of the inflammatory response.
    Romaschin AD, Foster DM, Walker PM, Marshall JC., Sepsis 1998; 2: 119-125.

Frequently Asked Questions

Why a whole blood test?

• Whole blood enhances assay sensitivity to endotoxin >1000 fold compared to  buffers

• LBP and sCD-14 disaggregate LPS and expose the Lipid A epitope for antibody binding
   

Is the EAA susceptible to contamination?

Compared to the LAL, the EAA™ is much less susceptible to contamination because only direct contamination of the blood will have the biggest impact on a false positive result.  With the LAL any of the reagents are about equally prone to contamination.
 

Why is there a “max” tube?

Endotoxin activity is expressed in arbitrary units derived from the integral of the sample chemiluminescent response over time, and calibrated so that 0 units represents endotoxin activity in the absence of antibody, and 1.0 represents activity following the addition of a maximally stimulatory dose of LPS (4600 pg/ml).
 

Can heparinised blood tubes be used?

The problem with heparinized tubes is the chance that the heparin is contaminated with endotoxin.  This has been documented in previous papers. Furthermore EDTA storage of PMN's prevents some cell to cell homotypic aggregation and is more appropriate for chemiluminescence.