Observations in COVID-19 similar to the immune response in sepsis: bacterial endotoxin mediates proinflammatory signaling, activates the innate immune system through and “leads to overproduction of pro-inflammatory cytokines”.
In the absence of a bacterial infection, antibiotic treatment can cause release of endotoxin, triggering endotoxemia and over-production of pro-inflammatory cytokines - an antibiotic-induced inflammatory storm.
Binding and clearing endotoxins from circulation could be an appropriate intervention in the fight against COVID-19. 90% of patients with severe pulmonary forms of COVID-19 had increased endotoxin levels. Comorbidities of COVID-19 are connected via viral–bacterial interactions, initiated by translocation of bacterial products such as endotoxin from the gut into circulation. Increased levels of endotoxin are found in diabetes, obesity, cardiovascular diseases, older individuals but are lower in women.
ECMO is associated with an endotoxin-related, generalized inflammatory state. "The pulmonary, renal, and cardiac dysfunctions documented with prolonged bypass can all be related to a classic sepsis syndrome."