Relationship of preoperative antiendotoxin core antibodies and adverse outcomes following cardiac surgery

E. Bennett-Guerrero, L. Ayuso, C. Hamilton-Davies, W. D. White, G. R. Barclay, P. K. Smith, S. A. King, L. H. Muhlbaier, M. F. Newman and M. G. Mythen
Department of Anesthesiology, The Mount Sinai Medical Center, New York, NY 10029-6574, USA.

OBJECTIVE: To test the hypothesis that low serum antiendotoxin core antibody (EndoCAb) level is an independent predictor of adverse outcome following cardiac surgery. DESIGN: Prospective, blinded, cohort study. SETTING: Tertiary care medical center. SUBJECTS: A total of 301 patients undergoing coronary artery bypass graft surgery and/or valvular heart surgery. DESIGN: Preoperative serum was assayed for IgM EndoCAb, IgG EndoCAb, total IgM, and total IgG levels. Known preoperative risk factors were assessed, and patients were assigned a risk score using a validated method. MAIN OUTCOME MEASURE: A major complication, defined as either in-hospital death or postoperative length of stay greater than 10 days. RESULTS: Overall, a major complication occurred in 34 patients (11.3%). Lower IgM EndoCAb level independently predicted (P=.002) increased risk of major complication over and above the effects of preoperative risk score (P=.02), total IgG level (P=.07), and all other known perioperative risk factors. In contrast, IgG Endo-CAb and total IgM concentrations did not predict outcome. No association existed between risk score and level of IgM EndoCAb. CONCLUSION: There is marked preoperative variability in humoral immunity against endotoxin core, which is not accounted for by differences in known preoperative risk factors. In this study, low levels of IgMEndoCAb were an important independent predictor of adverse postoperative outcome, which supports the theory that endotoxemia is a cause of postoperative morbidity.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Systemic antibody response to Clostridium difficile in colonized patients with and without symptoms and matched controls
Sanchez-Hurtado et al.
J Med Microbiol 2008;57:717-724.
ABSTRACT | FULL TEXT  

Analytic Reviews: Cardiac Surgery as a Cause of Acute Kidney Injury: Pathogenesis and Potential Therapies
Rosner et al.
J Intensive Care Med 2008;23:3-18.
ABSTRACT  

A Phase II, Double-Blind, Placebo-Controlled, Ascending-Dose Study of Eritoran (E5564), a Lipid A Antagonist, in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass
Bennett-Guerrero et al.
Anesth. Analg. 2007;104:378-383.
ABSTRACT | FULL TEXT  

Neutrophil Elastase Inhibitor, Sivelestat, Attenuates Acute Lung Injury After Cardiopulmonary Bypass in the Rabbit Endotoxemia Model
Wakayama et al.
Ann. Thorac. Surg. 2007;83:153-160.
ABSTRACT | FULL TEXT  

Effects of Decreased Preoperative Endotoxin Core Antibody Levels on Long-term Mortality After Coronary Artery Bypass Graft Surgery
Moretti et al.
Arch Surg 2006;141:637-641.
ABSTRACT | FULL TEXT  

Acute Kidney Injury Associated with Cardiac Surgery
Rosner and Okusa
CJASN 2006;1:19-32.
ABSTRACT | FULL TEXT  

Preoperative anti-PF4/heparin antibody level predicts adverse outcome after cardiac surgery
Bennett-Guerrero et al.
J. Thorac. Cardiovasc. Surg. 2005;130:1567-1572.
ABSTRACT | FULL TEXT  

Why Employed Latinos Lack Health Insurance: A Study in California
Greenwald et al.
Hispanic Journal of Behavioral Sciences 2005;27:517-532.
ABSTRACT  

Low-dose endotoxin elicits variability in the inflammatory response in healthy volunteers
Stephens et al.
Innate Immunity 2005;11:207-212.
ABSTRACT  

Postoperative Gastrointestinal Tract Dysfunction
Mythen
Anesth. Analg. 2005;100:196-204.
ABSTRACT | FULL TEXT  

The distribution of, and antibody response to, the core lipopolysaccharide region of Escherichia coli isolated from the faeces of healthy humans and cattle
Gibbs et al.
J Med Microbiol 2004;53:959-964.
ABSTRACT | FULL TEXT  

Abdominal Organ Injury After Cardiac Surgery
Hessel
SEMIN CARDIOTHORAC VASC ANESTH 2004;8:243-263.
ABSTRACT  

Preoperative optimization of the high-risk surgical patient
Davies and Wilson
Br J Anaesth 2004;93:121-128.
ABSTRACT | FULL TEXT  

A descriptive study of the variation in baseline levels of anti-endotoxin core antibodies between US and UK populations
Down et al.
Innate Immunity 2004;10:195-196.
ABSTRACT  

Lower Endotoxin Immunity Predicts Increased Cognitive Dysfunction in Elderly Patients After Cardiac Surgery
Mathew et al.
Stroke 2003;34:508-513.
ABSTRACT | FULL TEXT  

The clinical relevance of endotoxin in human sepsis: a critical analysis
Opal
Innate Immunity 2002;8:473-476.
ABSTRACT  

Intraoperative Tachycardia and Hypertension Are Independently Associated with Adverse Outcome in Noncardiac Surgery of Long Duration
Reich et al.
Anesth. Analg. 2002;95:273-277.
ABSTRACT | FULL TEXT  

The biological activity of a liposomal complete core lipopolysaccharide vaccine
Erridge et al.
Innate Immunity 2002;8:39-46.
ABSTRACT  

Preoperative and Intraoperative Predictors of Postoperative Morbidity, Poor Graft Function, and Early Rejection in 190 Patients Undergoing Liver Transplantation
Bennett-Guerrero et al.
Arch Surg 2001;136:1177-1183.
ABSTRACT | FULL TEXT  

The Inflammatory Response to Cardiopulmonary Bypass-- Should It Be Treated?
Hill
SEMIN CARDIOTHORAC VASC ANESTH 2001;5:229-235.
ABSTRACT  

The impact of anti-endotoxin core antibodies on endotoxin and cytokine release and ventilation time after cardiac surgery
Rothenburger et al.
J Am Coll Cardiol 2001;38:124-130.
ABSTRACT | FULL TEXT  

Preparation and Preclinical Evaluation of a Novel Liposomal Complete-Core Lipopolysaccharide Vaccine
Bennett-Guerrero et al.
Infect. Immun. 2000;68:6202-6208.
ABSTRACT | FULL TEXT  

Endotoxin in pooled pericardial blood contributes to the systemic inflammatory response during cardiac surgery
Spanier et al.
Perfusion 2000;15:427-431.
ABSTRACT  

Preoperative and Postoperative Endotoxemia in Children With Congenital Heart Disease
Lequier et al.
Chest 2000;117:1706-1712.
ABSTRACT | FULL TEXT  

Exposure to Bacteroides fragilis Endotoxin During Cardiac Surgery
Bennett-Guerrero et al.
Anesth. Analg. 2000;90:819-823.
ABSTRACT | FULL TEXT  

Mesenteric dysfunction after cardiopulmonary bypass: role of complement C5a
Tofukuji et al.
Ann. Thorac. Surg. 2000;69:799-807.
ABSTRACT | FULL TEXT  

Intraoperative Hemodynamic Predictors of Mortality, Stroke, and Myocardial Infarction After Coronary Artery Bypass Surgery
Reich et al.
Anesth. Analg. 1999;89:814-814.
ABSTRACT | FULL TEXT  

DOES STEROID PRETREATMENT INCREASE ENDOTOXIN RELEASE DURING CLINICAL CARDIOPULMONARY BYPASS?
Wan et al.
J. Thorac. Cardiovasc. Surg. 1999;117:1004-1008.
ABSTRACT | FULL TEXT  

Variables Affecting Outcome in Critically Ill Patients
Chernow
Chest 1999;115:71S-76S.
ABSTRACT | FULL TEXT  

All Accessible Epitopes in the Salmonella Lipopolysaccharide Core Are Associated with Branch Residues
Nnalue
Infect. Immun. 1999;67:998-1003.
ABSTRACT | FULL TEXT  

alpha -GlcNAc-1right-arrow2-alpha -Glc, the Salmonella Homologue of a Conserved Lipopolysaccharide Motif in the Enterobacteriaceae, Elicits Broadly Cross-Reactive Antibodies
Nnalue
Infect. Immun. 1998;66:4389-4396.
ABSTRACT | FULL TEXT  

Novel Insights Into the Pathogenesis and Therapy of Circulatory Shock
Steingrub
SEMIN CARDIOTHORAC VASC ANESTH 1998;2:31-45.
ABSTRACT