title: Lower endotoxin immunity predicts increased cognitive dysfunction in elderly patients after cardiac surgery.
abstract: OBJECTIVE
  Although coronary artery bypass graft surgery (CABG) improves the quality of life and functional capacity for numerous patients, many also exhibit impairment in cognitive function immediately after surgery. Although the etiology of this cognitive decline is multifactorial, the inflammatory response to the primary insult may modulate the extent of dysfunction. Patients with low preoperative levels of anti-endotoxin core antibody (EndoCAb) are more likely to experience adverse outcomes, suggesting that decreased immunity to endotoxin causes a heightened release of inflammatory mediators. We therefore sought to determine the association of decreased EndoCAb and the incidence of postoperative cognitive decline.
  
  
  METHODS
  EndoCAb levels were measured before surgery in 460 patients undergoing elective CABG. Cognitive function was measured preoperatively and 6 weeks postoperatively. Multivariable analysis accounted for the effects of age, Parsonnet score, sex, body mass index, baseline cognition, years of education, history of hypertension, bypass time, cross-clamp time, and number of grafts.
  
  
  RESULTS
  At 6-week follow-up, 122 patients (36%) showed cognitive decline. Lower preoperative EndoCAb levels were associated with a greater incidence and severity of postoperative cognitive decline. The elderly with decreased endotoxin immunity are particularly susceptible to this decline (relative risk=1.97 for age >64).
  
  
  CONCLUSIONS
  Reduced preoperative endotoxin immunity is a predictor of increased postoperative cognitive dysfunction in patients undergoing CABG, particularly in those >60 years old. Interventions that increase IgM EndoCAb levels might improve cognitive function after cardiac surgery.
authors.affiliation: Department of Anesthesiology
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Mathew
authors.forename: Hilary P
authors.initials: HP
authors.lastname: Grocott
authors.forename: Barbara
authors.initials: B
authors.lastname: Phillips-Bute
authors.forename: Mark
authors.initials: M
authors.lastname: Stafford-Smith
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Laskowitz
authors.forename: Daniel
authors.initials: D
authors.lastname: Rossignol
authors.forename: James A
authors.initials: JA
authors.lastname: Blumenthal
authors.forename: Mark F
authors.initials: MF
authors.lastname: Newman
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000097:blood; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004731:Endotoxins / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D000907:Antibodies, Bacterial; D004731:Endotoxins; D007075:Immunoglobulin M