Preoperative apolipoprotein CI levels correlate positively with the proinflammatory response in patients experiencing endotoxemia following elective cardiac surgery.
OBJECTIVE
Experimental models show that apolipoprotein CI (apoCI) binds and enhances the inflammatory response to endotoxin. We studied in patients undergoing cardiopulmonary bypass surgery (CPB) and experiencing endotoxemia during reperfusion whether plasma apoCI levels correlate with the inflammatory response and perioperative cytokine release.


METHODS
Prospective, observational, clinical cohort study.


METHODS
Operating room (OR) and intensive care unit (ICU) of a university hospital.


METHODS
One hundred fifty-nine consecutive patients > 18 years of age (66% males =105), median age 65 and 67 years for males and females, respectively) undergoing elective cardiothoracic surgery with cardiopulmonary bypass.


METHODS
None.


METHODS
Baseline apoCI, apoCIII, total cholesterol and triglyceride levels, and perioperative endotoxin and TNF-alpha levels were determined.


RESULTS
High preoperative plasma apoCI, but not apoCIII, levels were associated (p < 0.05) with increased perioperative levels of TNF-alpha in patients experiencing endotoxemia. This association was not observed in patients without endotoxemia.


CONCLUSIONS
High plasma apoCI is positively related to proinflammatory response in patients experiencing endotoxemia and confirms the observations in animal models.
Schippers
Emile F
EF
Department of Infectious Diseases, Leiden University Medical Center,Leiden, The Netherlands. E.F.Schippers@lumc.nl
Berbée
Jimmy F P
JF
van Disseldorp
Inge M
IM
Versteegh
Michael I M
MI
Havekes
Louis M
LM
Rensen
Patrick C N
PC
van Dissel
Jaap T
JT
D000368:Aged; D053302:Apolipoprotein C-I / Q000097:blood*; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002784:Cholesterol / Q000097:blood; D017558:Elective Surgical Procedures; D019446:Endotoxemia / Q000378:metabolism*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood*; D011237:Predictive Value of Tests; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
D053302:Apolipoprotein C-I; D014409:Tumor Necrosis Factor-alpha; D002784:Cholesterol