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Endotoxemia and mediator release during cardiac surgery
E Boelke1, M Storck, K Buttenschoen
1Department of Thoracic and Vascular Surgery, University of Ulm, Germany.
Angiology
|September 22, 2000
Summary
Cardiac surgery triggers endotoxemia and inflammation. This study found increased endotoxin levels during surgery, correlating with elevated inflammatory markers like interleukin-6 and C-reactive protein post-operation.
Area of Science:
- Cardiovascular Surgery
- Immunology
- Critical Care Medicine
Background:
- Endotoxemia, while debated in humans, is a known potent inflammatory trigger.
- Investigating endotoxin's role in cardiac surgery is crucial due to the inflammatory response it elicits.
Purpose of the Study:
- To investigate endotoxin translocation and mediator release in patients undergoing cardiac surgery.
- To assess the correlation between endotoxin levels and key inflammatory markers.
Main Methods:
- Plasma concentrations of endotoxin, IL-6, and CRP were measured in 40 cardiac surgery patients.
- Myeloid-related proteins (MRP8, MRP14, MRP8/14) were analyzed in a subgroup of 10 patients.
- Measurements were taken during and after cardiopulmonary bypass.
Main Results:
- A significant increase in plasma endotoxin was observed during surgery, peaking at reperfusion (0.82 EU/mL).
- Interleukin-6 (IL-6) levels peaked 6 hours postoperatively (218 pg/mL), and C-reactive protein (CRP) peaked on day 2 (191 mg/L).
- A significant correlation (p < 0.05) was found between intraoperative endotoxin and IL-6 levels.
Conclusions:
- Cardiac surgery is associated with significant endotoxemia and an acute-phase response.
- Endotoxin should be considered a pathophysiological mediator in this context.
- The gut as a source of endotoxemia post-cardiac surgery warrants further investigation.