van Deventer S J, Buller H R, ten Cate J W, Sturk A, Pauw W
Department of Internal Medicine, Slotervaart Hospital, The Netherlands.
Lancet. 1988 Mar 19;1(8586):605-9. doi: 10.1016/s0140-6736(88)91412-2.
In 473 consecutive febrile patients a sensitive and rapid chromogenic limulus assay was used to assess the value of endotoxaemia versus bacteraemia for predicting development of the syndrome of septicaemia. In each patient three blood specimens for culture and endotoxin testing were obtained at the onset of fever. Blood pressure, urinary output, and the occurrence of thrombocytopenia and metabolic acidosis were recorded prospectively during three days of follow-up. Septicaemia developed in 19 patients (4%). The sensitivity, specificity, and likelihood ratio for a positive result with the endotoxin assay were 79%, 96%, and 20, respectively. The corresponding indices for bacteraemia were 89%, 78%, and only 4. The results suggest that endotoxaemia is a clinically valid indicator for impending gram-negative septicaemia (positive predictive value 48%) and that the absence of endotoxaemia virtually rules out the risk that septicaemia will ensue (negative predictive value 99%).
在473例连续发热患者中，采用灵敏快速的显色鲎试剂法评估内毒素血症与菌血症对预测败血症综合征发生的价值。在每位患者发热开始时采集三份血标本进行培养和内毒素检测。在三天的随访期间前瞻性记录血压、尿量以及血小板减少症和代谢性酸中毒的发生情况。19例患者（4%）发生了败血症。内毒素检测阳性结果的敏感性、特异性和似然比分别为79%、96%和20。菌血症的相应指标分别为89%、78%和仅4。结果表明，内毒素血症是即将发生革兰阴性败血症的有效临床指标（阳性预测值48%），而无内毒素血症实际上排除了随后发生败血症的风险（阴性预测值99%）。
