title: Septic Participation in Cardiogenic Shock: Exposure to Bacterial Endotoxin.
abstract: In cardiogenic shock (CS), presence of fever, leukocytosis, relatively low systemic vascular resistances, and high serum procalcitonin levels are quite frequent and recurrently involve the search for an infectious complication. We hypothesized that endotoxin exposure in CS could explain this sepsis-like syndrome.
  
  
  
  Prospective observational study of consecutive CS patients admitted to our intensive care unit (ICU). Patients were followed during the first 3 days after CS onset. All clinical, hemodynamic, and microbiological data were collected. Inflammatory biomarkers and anti-endotoxin antibodies (IgM EndoCAb) were daily measured.
  
  
  
  We included 37 consecutive CS patients.
  
  
  
  Twenty-two patients (60%) had body temperature >38.3°C or <35°C; and 23 patients (62%) had a leucocyte count >14,000/mm or <4,000/mm. Microbiological study was performed in 30 patients (81%). No infection was diagnosed in the studied patients. All the patients had serum inflammatory biomarkers levels above normal values including procalcitonin (19 patients [51%] had serum procalcitonin above 2 ng/mL). All the patients had IgM EndoCAb below the normal median value; 22 patients (59.5%) had IgM anti-endotoxin value below 10th percentile range for healthy people. Hemodynamic and respiratory stabilization was achieved in 23 patients (62%) and the ICU mortality rate was 38%, only procalcitonin and interleuquin-6 were associated with higher mortality rate.
  
  
  
  We have detected extremely low titers of IgM EndoCAb in CS suggesting endotoxin exposure. However, only inflammatory biomarkers were related to ICU mortality.
authors.affiliation: *Critical Care Department, University Hospital la Fe, Valencia †Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Carlos III Research Institute, Madrid ‡Microbiology Department, University Hospital la Fe §Laboratory Department, University Hospital la Fe, Valencia ||Department of Microbiology, Hospital Clinic, IDIBAPS, School of Medicine, University of Barcelona, Barcelona, Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: Ramirez
authors.forename: Esther
authors.initials: E
authors.lastname: Villarreal
authors.forename: Monica
authors.initials: M
authors.lastname: Gordon
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Gómez
authors.forename: Luis
authors.initials: L
authors.lastname: de Hevia
authors.forename: Karla
authors.initials: K
authors.lastname: Vacacela
authors.forename: Teresa
authors.initials: T
authors.lastname: Gisbert
authors.forename: Adrian
authors.initials: A
authors.lastname: Quinzá
authors.forename: Jesús
authors.initials: J
authors.lastname: Ruiz
authors.forename: Ricardo
authors.initials: R
authors.lastname: Alonso
authors.forename: Juan
authors.initials: J
authors.lastname: Bonastre
authors.forename: Jordi
authors.initials: J
authors.lastname: Vila
mesh_terms: D000368:Aged; D000906:Antibodies / Q000097:blood / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D019446:Endotoxemia / Q000150:complications* / Q000175:diagnosis*; D004731:Endotoxins / Q000097:blood / Q000276:immunology; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood / Q000276:immunology; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012770:Shock, Cardiogenic / Q000175:diagnosis* / Q000209:etiology*; D012772:Shock, Septic / Q000097:blood / Q000175:diagnosis / Q000209:etiology
chemical_list: D000906:Antibodies; D015415:Biomarkers; D004731:Endotoxins; D007075:Immunoglobulin M