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Updated: Aug 16, 2026
Endotoxin Activity Assay for the Detection of Whole Blood Endotoxemia in Critically Ill Patients
Published on: June 24, 2019
Preoperative and postoperative endotoxemia in children with congenital heart disease
L L Lequier1, H Nikaidoh, S R Leonard
1Department of Pediatrics,The University of Texas Southwestern Medical Center, Dallas 75235-9063, USA.
Insights
Endotoxemia is common in children with congenital heart disease, particularly before surgery. This bacterial toxin presence is linked to worse outcomes and higher mortality, suggesting endotoxin may play a role in disease progression.
Area of Science:
- Pediatric Cardiology
- Immunology
- Critical Care Medicine
Background:
- Elevated inflammatory cytokines are observed in various cardiac diseases.
- The primary trigger for cytokine release in cardiac illness is not well understood.
- Bacterial endotoxin is a known potent inducer of cytokines.
Purpose of the Study:
- To determine the incidence and magnitude of endotoxemia in children with congenital heart disease.
- To assess the clinical relevance of endotoxemia before and after surgical repair.
- To investigate the association between endotoxemia and clinical outcomes, including hemodynamic disturbances and mortality.
Main Methods:
- Prospective, observational study conducted at a tertiary-care children's hospital.
- Enrolled 30 children with congenital heart defects (median age, 59 days).
- Collected blood samples pre-surgery and at multiple time points post-cardiopulmonary bypass for endotoxin, lipopolysaccharide-binding protein (LBP), and interleukin-6 (IL-6) assays.
Main Results:
- 96% of patients showed evidence of endotoxemia during the study period.
- 40% of patients were significantly endotoxemic pre-surgery.
- Higher preoperative LBP and endotoxin levels correlated with severe postoperative hemodynamic disturbances and increased mortality (25% in endotoxemic vs. 0% in non-endotoxemic patients).
Conclusions:
- Endotoxemia is highly prevalent in children with congenital heart disease and is associated with adverse clinical outcomes.
- These findings suggest endotoxin may be a significant factor in the disease process.
- Further clinical trials targeting endotoxin are warranted to establish its causal role.
Study Objectives:
Recent data indicate that increases in inflammatory cytokines are seen in patients with diverse cardiac diseases. However, the primary stimulus for cytokine secretion during cardiac illness remains unknown. Since bacterial endotoxin is a potent inducer of cytokines, we determined the incidence, magnitude, and clinical relevance of endotoxemia in children with congenital heart disease before and after surgical repair.
Design:
A prospective, observational study.
Setting:
A large, urban, university-affiliated, tertiary-care children's hospital.
Patients:
Thirty children with a variety of congenital heart defects (median age, 59 days; median weight, 4.0 kg) were sequentially enrolled.
Interventions:
Blood was sampled prior to surgery, and at 1, 8, 24, 48, and 72 h following cardiopulmonary bypass. Assays included plasma endotoxin, lipopolysaccharide-binding protein (LBP), and interleukin-6 (IL-6).
Measurements And Results:
Twenty-nine of 30 patients (96%) had evidence of endotoxemia during the study period. Twelve of the 30 patients (40%) were significantly endotoxemic prior to surgery. LBP, a plasma marker that responds to bacteria and endotoxin, rose significantly following cardiopulmonary bypass, as did the plasma levels of IL-6. Fifteen of 30 patients met prospectively defined criteria for experiencing a severe hemodynamic disturbance in their postoperative course. These patients had significantly higher preoperative plasma LBP (p < 0.02) and plasma endotoxin levels (p < 0.05), compared to patients with less-severely disturbed hemodynamics. Mortality was 25% in patients with preoperative endotoxemia, compared with no mortality in patients who were not endotoxemic before surgery (p = 0.05).
Conclusions:
These data demonstrate that endotoxemia in children with congenital heart disease is more common than previously suspected, and is associated with clinical outcomes. We conclude that clinical trials targeting endotoxin will be necessary to determine if endotoxin is a causal, etiologic agent in the disease process.
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