Effects of decreased preoperative endotoxin core antibody levels on long-term mortality after coronary artery bypass graft surgery.
OBJECTIVE
Decreased preoperative levels of antiendotoxin core antibody (EndoCAb) in patients undergoing cardiac surgery with cardiopulmonary bypass are associated with increased long-term mortality.


METHODS
Observational study.


METHODS
Academic medical center.


METHODS
A total of 474 patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass.


METHODS
Preoperative serum IgM EndoCAb levels were determined, and established preoperative risk factors were assessed. Patients were assigned a risk score using a validated method.


METHODS
The primary end point was mortality. Statistical analysis used the Cox proportional hazards regression model with log EndoCAb as the predictor of interest and Parsonnet additive risk score as a covariate. Kaplan-Meier survival curves were generated to visually compare groups with high vs low EndoCAb levels.


RESULTS
Forty-six deaths occurred in 5 years. Annual follow-up rates during the 5 years were 100%, 94%, 93%, 98%, and 98% for the 1-, 2-, 3-, 4-, and 5-year periods, respectively. Parsonnet additive risk score (hazard ratio, 1.07; 95% confidence interval [CI], 1.04-1.11; P < .001) and log EndoCAb (hazard ratio, 0.73; 95% CI, 0.53-0.99; P = .04) were independent predictors of long-term mortality in the final model. Kaplan-Meier analysis revealed that the preoperative EndoCAb level was significantly associated with mortality up to 5 years (P = .01 by log-rank test).


CONCLUSIONS
Lower preoperative serum EndoCAb level is a significant predictor of long-term mortality independent of other known risk factors.
Moretti
Eugene W
EW
Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA. moret002@mc.duke.edu
Newman
Mark F
MF
Muhlbaier
Lawrence H
LH
Whellan
David
D
Petersen
Rebecca P
RP
Rossignol
Daniel
D
McCants
Charles B
CB
Phillips-Bute
Barbara
B
Bennett-Guerrero
Elliott
E
D015415:Biomarkers / Q000097:blood; D001026:Coronary Artery Bypass / Q000401:mortality*; D003327:Coronary Disease / Q000276:immunology* / Q000401:mortality* / Q000601:surgery; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology*; D007136:Immunoglobulins / Q000097:blood* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
D015415:Biomarkers; D007074:Immunoglobulin G; D007136:Immunoglobulins; C042866:antilipopolysaccharide antibodies