In Reply Dr Hurley suggests endotoxin may not play a role in septic shock, leading to the disappointing outcomes of the EUPHRATES trial.1 We agree that endotoxin is simply one of many potential mediators of septic shock, although the human evidence that it can cause the condition is incontrovertible.2 We enriched our population of patients with elevated endotoxin levels through the use of the endotoxin-activity assay, targeting only those with activity levels greater than 0.6. We also agree that endotoxemia is not unique to sepsis but rather present in a number of acute life-threatening disorders and conversely absent in some patients who meet sepsis criteria.3
Marshall JC, Walker PM, Dellinger RP. The Role of Endotoxin in Septic Shock—Reply. JAMA. 2019;321(9):903. doi:10.1001/jama.2018.20882
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