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February 26, 1997

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

Author Affiliations

From the Department of Anesthesiology, The Mount Sinai Medical Center, New York, NY (Dr Bennett-Guerrero); Harvard Medical School, Boston, Mass (Ms Ayuso); the Department of Anesthesiology, Middlesex Hospital, London, United Kingdom (Dr Hamilton-Davies); the Departments of Anesthesiology (Drs Newman and Mythen and Mr White), Surgery (Dr Smith and Ms King), and Community and Family Medicine (Dr Muhlbaier), Duke Heart Center, Duke University Medical Center, Durham, NC; and the Scottish National Blood Transfusion Service, Edinburgh, United Kingdom (Dr Barclay).

JAMA. 1997;277(8):646-650. doi:10.1001/jama.1997.03540320048034

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.