Severity and prognostic assessment of the endotoxin activity assay in biliary tract infection

Background Acute cholangitis and cholecystitis (AC) often progress to severe septic conditions. We evaluated the endotoxin activity assay (EAA) for assessment and prediction of the severity of AC. Methods We retrospectively reviewed 98 patients diagnosed with AC. We divided them into low (<0.4) and high (0.4) groups based on EAA values. Results Endotoxin levels showed no correlation with EAA values. Serum C-reactive protein (8.57 vs. 5.23mg/dl, P = 0.02), procalcitonin (2.45 vs. 0.48ng/ml, P = 0.004), and the positive culture rate of blood (50% vs. 15%, P < 0.001) were significantly higher in the high group than in the low group. Platelet counts were significantly lower in the high group than in the low group (23.9 vs. 13.5 104/ml, P = 0.004). The ratio of patients with a Japanese Association for Acute Medicine disseminated intravascular coagulation score 4 (32% vs. 14%, P = 0.032) was significantly higher in the high group than in the low group. There was a significantly higher percentage of patients with a severe grade of AC in the high group than patients with a mild or moderate grade (32% vs. 15%, P = 0.05). Conclusions Endotoxin activity assay is useful for assessment and early prediction of septic conditions due to AC.