Background/aims: The purpose of this study was to evaluate the occurrence of false-positive endotoxemia after hepatectomy for hepatocellular carcinoma in patients with cirrhosis. The chromogenic conventional limulus test (Toxicolor test) revealed transiently increased blood endotoxin levels after hepatic resection for hepatocellular carcinoma in patients with liver cirrhosis. However, clinical signs of endotoxemia were not observed in all of the cases.
Methodology: Pre- and postoperative changes of blood endotoxin levels and beta-glucan were measured in 20 patients with liver cirrhosis who underwent hepatic resection for hepatocellular carcinoma, using the Toxicolor test, the Endospecy test (which specifically reacts with endotoxin) and the Gluspecy test (which specifically reacts with beta-glucan). The changes in endotoxin levels and beta-glucan in ascitic fluid during surgery were also studied.
Results: The Toxicolor test revealed transiently increased blood endotoxin levels, but Endospecy test results were not elevated. The changes in the Gluspecy test were almost the same as in the Toxicolor test. During surgery, beta-glucan levels in the ascitic fluid increased remarkably due to their release from the surgical gauze. Digestion studies using 1-3-beta-D-glucanase on specimens which showed high Toxicolor and Gluspecy test values resulted in a lack of response for both tests.
Conclusion: The cause of false-positive endotoxemia was determined to be caused by beta-glucan, which was released from the surgical gauze.