Relationship of Preoperative Antiendotoxin Core Antibodies and Adverse Outcomes Following Cardiac Surgery

Bennett-Guerrero, E.; Ayuso, Lucía; Hamilton-Davies, Colin; Wd, White; Barclay, G.R.; Pk, Smith; Sa, King; Lh, Muhlbaier; Mf, Newman; Mythen, MG

doi:10.1001/jama.1997.03540320048034

Cited by 124 publications

(52 citation statements)

References 42 publications

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“…Thus, targeting immune function is an increasingly important line of investigation in efforts to reduce the substantial mortality from the increasing prevalence of cardiac failure. Strikingly, similar data from the perioperative literature supports this concept: patients with evidence for preoperative depletion of antibodies to endotoxin exhibit higher levels of proinflammatory cytokines and sustain more perioperative morbidity [32, 33]. Downregulation of CD14 + is consistent with the hypothesis that chronic systemic exposure to low plasma levels of endotoxin occurs as a result of (occult) cardiac failure [34, 35].…”

Section: Discussionmentioning

confidence: 68%

Cardiopulmonary Exercise Capacity and Preoperative Markers of Inflammation

Sultan

Edwards

Arroyo

et al. 2014

Mediators of Inflammation

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Explanatory mechanisms for the association between poor exercise capacity and infections following surgery are underexplored. We hypothesized that aerobic fitness—assessed by cardiopulmonary exercise testing (CPET)—would be associated with circulating inflammatory markers, as quantified by the neutrophil-lymphocyte ratio (NLR) and monocyte subsets. The association between cardiopulmonary reserve and inflammation was tested by multivariable regression analysis with covariates including anaerobic threshold (AT) and malignancy. In a first cohort of 240 colorectal patients, AT was identified as the sole factor associated with higher NLR (P = 0.03) and absolute and relative lymphopenia (P = 0.01). Preoperative leukocyte subsets and monocyte CD14+ expression (downregulated by endotoxin and indicative of chronic inflammation) were also assessed in two further cohorts of age-matched elective gastrointestinal and orthopaedic surgical patients. Monocyte CD14+ expression was lower in gastrointestinal patients (n = 43) compared to age-matched orthopaedic patients (n = 31). The circulating CD14+CD16− monocyte subset was reduced in patients with low cardiopulmonary reserve. Poor exercise capacity in patients without a diagnosis of heart failure is independently associated with markers of inflammation. These observations suggest that preoperative inflammation associated with impaired cardiorespiratory performance may contribute to the pathophysiology of postoperative outcome.

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Section: Discussionmentioning

confidence: 68%

Cardiopulmonary Exercise Capacity and Preoperative Markers of Inflammation

Sultan

Edwards

Arroyo

et al. 2014

Mediators of Inflammation

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“…7 The findings presented herein suggest that endotoxin in pooled pericardial blood is an important primary source of systemic endotoxemia. It is intriguing to consider that removal of endotoxin antigen shed in pericardial blood, prior to its rein-430 T Spanier et al Tissue Injury Multiple Organ Dysfunction fusion into the CPB circuit, may provide a directed strategy to attenuate the SIR, thereby influencing perioperative outcome without compromising established blood-conserving techniques.…”

Section: Discussionmentioning

confidence: 71%

Endotoxin in pooled pericardial blood contributes to the systemic inflammatory response during cardiac surgery

et al. 2000

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Although endotoxin has been implicated as an important contributor to the systemic inflammatory response (SIR) during cardiopulmonary bypass (CPB), its source remains unclear. While gut translocation has traditionally been perceived as the primary source of endotoxemia, accumulation of endotoxin in pooled pericardial blood may represent an additional source of endotoxin that is continually reinfused into the CPB circuit. Eighteen patients undergoing primary coronary revascularization procedures were prospectively evaluated. Shed blood pooled in the pericardial space was returned to the CPB circuit through cardiotomy suction catheters at 45 min after placement of the aortic cross-clamp. Simultaneous samples of pooled pericardial and peripheral arterial blood were obtained and analyzed by a limulus amebocyte lysate assay for the determination of endotoxin concentration, and an enzyme-linked immunosorbent assay for tumor necrosis factor (TNF-alpha) levels. Significant elevations in endotoxin were demonstrated in pooled pericardial blood samples compared with arterial blood (3.5 +/- 0.5 vs 0.8 +/- 0.2 pg/ml; p < 0.05). TNF-alpha levels were below the limits of detection in both samples. These data implicate pooled pericardial blood as an important primary source of endotoxin that, when continually reinfused throughout CPB, may contribute to the overall SIR. Because endotoxemia has been identified as an important predictor of adverse outcomes following cardiac surgery, removal of endotoxin antigen in shed pericardial blood, prior to its reinfusion into the CPB circuit, may provide a directed means to improve perioperative outcome without compromising established blood conservation techniques.

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“…Length of stay alone as a marker of postoperative morbidity can be confounded by various issues, including the presence of early death. Therefore, similar to other previous studies, we used a composite endpoint of death or prolonged (>10 days) length of stay as a reasonable surrogate for adverse postoperative outcome [30]. Given a median length of stay of 7 days, a stay greater than 10 days is unlikely to be explained by "soft" factors (e.g., waiting for transportation) in most patients.…”

Section: Discussionmentioning

confidence: 99%