Relationship of preoperative antiendotoxin core antibodies and adverse outcomes following cardiac surgery.
OBJECTIVE
To test the hypothesis that low serum antiendotoxin core antibody (EndoCAb) level is an independent predictor of adverse outcome following cardiac surgery.


METHODS
Prospective, blinded, cohort study.


METHODS
Tertiary care medical center.


METHODS
A total of 301 patients undergoing coronary artery bypass graft surgery and/or valvular heart surgery.


METHODS
Preoperative serum was assayed for IgM EndoCAb, IgG EndoCAb, total IgM, and total IgG levels. Known preoperative risk factors were assessed, and patients were assigned a risk score using a validated method.


METHODS
A major complication, defined as either in-hospital death or postoperative length of stay greater than 10 days.


RESULTS
Overall, a major complication occurred in 34 patients (11.3%). Lower IgM EndoCAb level independently predicted (P=.002) increased risk of major complication over and above the effects of preoperative risk score (P=.02), total IgG level (P=.07), and all other known perioperative risk factors. In contrast, IgG Endo-CAb and total IgM concentrations did not predict outcome. No association existed between risk score and level of IgM EndoCAb.


CONCLUSIONS
There is marked preoperative variability in humoral immunity against endotoxin core, which is not accounted for by differences in known preoperative risk factors. In this study, low levels of IgMEndoCAb were an important independent predictor of adverse postoperative outcome, which supports the theory that endotoxemia is a cause of postoperative morbidity.
Bennett-Guerrero
E
E
Department of Anesthesiology, The Mount Sinai Medical Center, New York, NY 10029-6574, USA.
Ayuso
L
L
Hamilton-Davies
C
C
White
W D
WD
Barclay
G R
GR
Smith
P K
PK
King
S A
SA
Muhlbaier
L H
LH
Newman
M F
MF
Mythen
M G
MG
D000368:Aged; D000704:Analysis of Variance; D006348:Cardiac Surgical Procedures / Q000401:mortality; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000276:immunology* / Q000601:surgery; D019446:Endotoxemia / Q000209:etiology / Q000276:immunology*; D005260:Female; D006349:Heart Valve Diseases / Q000276:immunology* / Q000601:surgery; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007136:Immunoglobulins / Q000097:blood*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000276:immunology*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D012307:Risk Factors; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000276:immunology
D007074:Immunoglobulin G; D007075:Immunoglobulin M; D007136:Immunoglobulins; C042866:antilipopolysaccharide antibodies