SEPTIC PARTICIPATION IN CARDIOGENIC SHOCK: EXPOSURE TO BACTERIAL ENDOTOXIN

Autores de IIS La Fe

• Paula Ramírez Galleymore

  Autor

• Esther Villarreal Tello

  Autor

• Mónica Gordón Sahuquillo

  Autor

• María Dolores Gómez Ruiz

  Autor

• Luis Maria De Hevia Benlliure

  Autor

• José Adrián Quinza Real

  Autor

• Juan Ruiz Manzano

  Autor

• Rosario Alonso Estellés

  Autor

• Juan Manuel Bonastre Mora

  Autor

• Juan José Vila Carbó

  Autor

Participantes ajenos a IIS La Fe

• Vacacela, K
• Gisbert, T

Grupos

• Hepatología experimental y Trasplante hepático

• Infección Grave

• Infecciones Respiratorias

• Investigacion clínica en enfermedades crónicas e Infección por el VIH

• Medicina Intensiva

Abstract

Objective: In cardiogenic shock (CS), presence of fever, leukocytosis, relatively low systemic vascular resistances, and high serum procalcitonin levels are quite frequent and recurrently involve the search for an infectious complication. We hypothesized that endotoxin exposure in CS could explain this sepsis-like syndrome. Design and Setting: Prospective observational study of consecutive CS patients admitted to our intensive care unit (ICU). Patients were followed during the first 3 days after CS onset. All clinical, hemodynamic, and microbiological data were collected. Inflammatory biomarkers and anti-endotoxin antibodies (IgM EndoCAb) were daily measured. Patients: We included 37 consecutive CS patients. Measurements and Main Results: Twenty-two patients (60%) had body temperature >38.3 degrees C or <35 degrees C; and 23 patients (62%) had a leucocyte count >14,000/mm(3) or <4,000/mm(3). Microbiological study was performed in 30 patients (81%). No infection was diagnosed in the studied patients. All the patients had serum inflammatory biomarkers levels above normal values including procalcitonin (19 patients [51%] had serum procalcitonin above 2 ng/mL). All the patients had IgM EndoCAb below the normal median value; 22 patients (59.5%) had IgM anti-endotoxin value below 10th percentile range for healthy people. Hemodynamic and respiratory stabilization was achieved in 23 patients (62%) and the ICU mortality rate was 38%, only procalcitonin and interleuquin-6 were associated with higher mortality rate. Conclusion: We have detected extremely low titers of IgM EndoCAb in CS suggesting endotoxin exposure. However, only inflammatory biomarkers were related to ICU mortality.

Keywords

• Cardiogenic shock; endotoxin; procalcitonin; sepsis-like syndrome