The impact of anti-endotoxin core antibodies on endotoxin and cytokine release and ventilation time after cardiac surgery.
J Am Coll Cardiol
; 38(1): 124-30, 2001 Jul.
Article
em En
| MEDLINE
| ID: mdl-11451261
ABSTRACT
OBJECTIVES:
We hypothesized that a temporary cardiopulmonary bypass (CPB)-induced reduction of endotoxin antibody levels contributes to elevated endotoxin levels and the associated inflammatory consequences, with a significant influence on the postoperative ventilation time period.BACKGROUND:
Cardiac surgery using CPB induces a systemic inflammatory response syndrome with an associated risk of increased postoperative morbidity and mortality.METHODS:
A total of 100 consecutive patients undergoing elective coronary artery bypass graft surgery using CPB were prospectively investigated. Endotoxin core antibodies (immunoglobulin [Ig] M/IgG against lipid A and lipopolysaccharide), endotoxin, interleukin (IL)-1-beta, IL-6, IL-8 and tumor necrosis factor-alpha were measured serially from 24 h preoperatively until 72 h postoperatively.RESULTS:
Eighty-five patients had no complications (group 1), whereas 15 patients required prolonged ventilation (group 2). In both groups, there was a decrease of all antibodies 5 min after CPB onset, compared with baseline values (p < 0.001), an increase of endotoxin and IL-8 peaking at 30 min postoperatively (p < 0.001) and an increase of IL-6 peaking 3 h postoperatively (p < 0.001). In group 2, preoperative antibody levels were lower (p < 0.01)--specifically, the decrease in IgM was significantly stronger and of longer duration (p < 0.002)--and levels of endotoxin (p < 0.001) and IL-8 (p < 0.001) were higher at 30 min postoperatively.CONCLUSIONS:
We conclude that an CPB-associated temporary reduction of anti-endotoxin core antibody levels contributes to elevated endotoxin and IL-8 release. Furthermore, lower levels of IgM anti-endotoxin core antibodies were associated with a greater rise in endotoxin and IL-8, as well as prolonged respirator dependence.
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Base de dados:
MEDLINE
Assunto principal:
Respiração Artificial
/
Imunoglobulina G
/
Imunoglobulinas
/
Ponte Cardiopulmonar
/
Ponte de Artéria Coronária
/
Citocinas
/
Endotoxinas
Idioma:
En
Ano de publicação:
2001
Tipo de documento:
Article