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CLINICAL STUDY

The impact of anti-endotoxin core antibodies on endotoxin and cytokine release and ventilation time after cardiac surgery

Markus Rothenburger, MD^*, Rasjid Soeparwata, MD^*, Mario C. Deng, MD, FACC, FESC, Elmar Berendes, MD, Christof Schmid, MD^*, Tonny D. T. Tjan^*, Markus J. Wilhelm, MD^*, Michael Erren, MD, Dirk Böcker, MD^|| and Hans Heinrich Scheld, MD^*

^* Department of Cardiothoracic Surgery, University of Muenster, Muenster, Germany
Heart Failure Center, Columbia University, New York, New York, USA
Department of Anesthesiology and Operative Intensive Care, University of Muenster, Muenster, Germany
Institute for Clinical Laboratory Medicine, University of Muenster, Muenster, Germany
^|| Department of Cardiology and Angiology, University of Muenster, Muenster, Germany

Manuscript received November 10, 2000; revised manuscript received March 13, 2001, accepted March 29, 2001.

Reprint requests and correspondence: Dr. Markus Rothenburger, Department of Cardiothoracic Surgery, University of Muenster, Albert Schweitzer Strasse 33, 48129 Muenster, Germany
markus.rothenburger{at}thgms.uni-muenster.de

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.

Abbreviations and Acronyms   CABG = coronary artery bypass graft surgery   CPB = cardiopulmonary bypass   EDTA = ethylenediaminetetraacetic acid   Ig = immunoglobulin   IL = interleukin   LPS = lipopolysaccharide   TNF = tumor necrosis factor   TP = time point

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