The impact of anti-endotoxin core antibodies on endotoxin and cytokine release and ventilation time after cardiac surgery.
OBJECTIVE
We hypothesized that a temporary cardiopulmonary bypass (CPB)-induced reduction of endotoxin antibody levels contributes to elevated endotoxin levels and the associated inflammatory consequences, with a significant influence on the postoperative ventilation time period.


BACKGROUND
Cardiac surgery using CPB induces a systemic inflammatory response syndrome with an associated risk of increased postoperative morbidity and mortality.


METHODS
A total of 100 consecutive patients undergoing elective coronary artery bypass graft surgery using CPB were prospectively investigated. Endotoxin core antibodies (immunoglobulin [Ig] M/IgG against lipid A and lipopolysaccharide), endotoxin, interleukin (IL)-1-beta, IL-6, IL-8 and tumor necrosis factor-alpha were measured serially from 24 h preoperatively until 72 h postoperatively.


RESULTS
Eighty-five patients had no complications (group 1), whereas 15 patients required prolonged ventilation (group 2). In both groups, there was a decrease of all antibodies 5 min after CPB onset, compared with baseline values (p < 0.001), an increase of endotoxin and IL-8 peaking at 30 min postoperatively (p < 0.001) and an increase of IL-6 peaking 3 h postoperatively (p < 0.001). In group 2, preoperative antibody levels were lower (p < 0.01)--specifically, the decrease in IgM was significantly stronger and of longer duration (p < 0.002)--and levels of endotoxin (p < 0.001) and IL-8 (p < 0.001) were higher at 30 min postoperatively.


CONCLUSIONS
We conclude that an CPB-associated temporary reduction of anti-endotoxin core antibody levels contributes to elevated endotoxin and IL-8 release. Furthermore, lower levels of IgM anti-endotoxin core antibodies were associated with a greater rise in endotoxin and IL-8, as well as prolonged respirator dependence.
Rothenburger
M
M
Department of Cardiothoracic Surgery, University of Muenster, Germany. markus.rothenburger@thgms.uni-muenster.de
Soeparwata
R
R
Deng
M C
MC
Berendes
E
E
Schmid
C
C
Tjan
T D
TD
Wilhelm
M J
MJ
Erren
M
M
Böcker
D
D
Scheld
H H
HH
D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D016207:Cytokines / Q000097:blood*; D004731:Endotoxins / Q000097:blood*; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007136:Immunoglobulins / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial; D013997:Time Factors
D016207:Cytokines; D004731:Endotoxins; D007074:Immunoglobulin G; D007136:Immunoglobulins; D015850:Interleukin-6; D016209:Interleukin-8; C042866:antilipopolysaccharide antibodies