Phosphorylated toll-like receptor 4 defines a high-risk sepsis endotype
Authors' conclusion
In vivo activation of TLR4 is not uniformly present in patients with sepsis but occurs only in a subset of individuals. In those patients, increased activation is strongly associated with mortality.
Study context
- Population
- Patients with sepsis in the SepsisDataNet.NRW cohort
- Participants
- 100 patients
- Exposure
- Elevated vs low TLR4 activation
- Outcome
- Association of TLR4 activation with mortality
- Follow-up
- 30 days
Methodological detailsbiomarker study
- Biomarker study
Main finding
As reported in the abstract
30-day mortality
Elevated activation vs Low activationHazard ratio (95% CI)P value
Day 1 sample
2.03(1.01–4.07)
P = 0.048Day 4 sample
2.77(1.14–6.73)
P = 0.025- Association remained significant after adjustment for SOFA at admission, age, infection focus and sex (multivariable Cox)
- P = 0.006
Observational data: associations, not effects.
Further findings
Overall TLR4 activation · day 1 and day 4
- Low overall; median below one signal per cell; a subgroup showed increased activation
Original publication
Phosphorylated toll-like receptor 4 defines a high-risk sepsis endotype. Crit Care. Published 30 May 2026. doi:10.
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