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. 5.23 mg/dl, P = 0.02), procalcitonin (2.45 vs. 0.48 ng/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 10 4 /ml, P = 0.004). The ratio of patients with a J apanese A ssociation for A cute M edicine 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 .