Anti-endotoxin antibodies consumption in cardiovascular collapse: Pathophysiological concerns.

Autores de IIS La Fe

• Esther Villarreal Tello

  Autor

• Paula Ramírez Galleymore

  Autor

• Mónica Gordón Sahuquillo

  Autor

• Carlos Vicent Perales

  Autor

• María Dolores Gómez Ruiz

  Autor

• Luis De Hevia Benlliure

  Autor

• Karla Vacacela

  Autor

• Ricardo Miguel Alonso Díaz

  Autor

Participantes ajenos a IIS La Fe

• Vila, J.

Grupos

• Infección Grave

  

  Investigador Principal

  María Ángeles Tormo Mas

• Infecciones Respiratorias

  Investigador Principal

  Raúl Méndez Ocaña

• Medicina Intensiva

  Leader

  Álvaro Castellanos Ortega

Abstract

OBJECTIVE: Abnormal endotoxin activity in critically ill patients has been described in the absence of Gram-negative bacterial (GNB) infection. As disease severity seems to be crucial in the detection of this phenomenon, we decided to assess and compare endotoxin exposure in those patients representing the critical situation: septic shock and cardiogenic shock. DESIGN: Prospective, observational non intervention study. SETTING: Critical Care Department of a University tertiary hospital. PATIENTS: Cardiogenic shock (CS) and septic shock (SS) patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Follow-up was performed for the first three days. Inflammatory biomarkers (C-reactive protein, procalcitonin and interleuquin-6) and IgM antiendotoxin-core antibodies titter (IgM EndoCAb) were daily analyzed. Sixty-two patients were included; twenty-five patients with SS and thirty-seven with CS. Microbial etiology was established in 23 SS patients (92%) and GNB were present in 13 cases (52%). Although infection was suspected and even treated in 30 CS patients (81%), any episode could be finally confirmed. EndoCAb consumption was more intense in SS patients, although twenty-two CS patients (59.5%) had IgM anti-endotoxin value below 10th percentile range for healthy people. No statistically significant difference in endotoxin exposure was detected between Gram-positive and Gram-negative infections in the SS group. Endotoxin exposure ability to distinguish between SS and CS was moderate (AUC 0.7892, 95% IC: 0.6564-0.9218). CONCLUSIONS: In the severely ill patient some mechanisms take place allowing endotoxin incursion and therefore blurring the limits of diseases pathophysiology. Our work representatively shows how exposure to endotoxin was not fully capable of distinguishing between CS and SS.

Keywords

• Endotoxin; Septic shock; Cardiogenic shock; Pathophysiology; Gram-negative bacteria