Relationship between plasma levels of lipopolysaccharide (LPS) and LPS-binding protein in patients with severe sepsis and septic shock

Plasma endotoxin and Lipopolysaccharide-binding protein (LBP) levels were measured in a group of 253 patients at the onset of severe sepsis and/or septic shock. Endotoxin levels were significantly greater than control levels (n = 33; mean +/- SD, 5.1 +/- 7.3 pg/mL) in 78.3% of patients. Median endotoxin levels in patients with sepsis were 300 pg/mL (25%-75% interquartile range, 110-726 pg/mL), LBP levels were elevated in 9746 of patients compared with normal control values of 4.1 +/- 1.65 mu g/mL. Median LBP levels in patients with sepsis were 31.2 mu g/mL (interquartile range, 22.5-47.7 mu g/mL). Median endotoxin levels at study entry were more highly elevated (515 vs. 230 pg/mL; P <.01), and LBP levels were less highly elevated (28.0 vs. 33.2 mu g/mL; P<.05) in nonsurvivors than survivors over the 28-day study period. No correlation was found between endotoxin and LBP levels. The quantitative level of both endotoxin and LBP may have prognostic significance in patients with severe sepsis.