TNF and serum lipopolysaccharide activity: LPS can be recognized by the toll-like receptor 4 (TLR4), a transmembrane receptor expressed in different immune cells, such as neutrophils, monocytes, macrophages, and dendritic cells.14 On activation, these cells produce inflammatory mediators, eg, the TNF and interleukins (IL-1beta, IL-6, IL-8, IL-10), which leads to the induction of a variety of inflammatory processes and may contribute to the development of major organ failure in the course of sepsis.15,16 Previous research indicates that endotoxemia is common in populations of ICU patients on the day of admission.