Anti-endotoxin antibodies consumption in cardiovascular collapse: Pathophysiological concerns

• Published in: Medicina intensiva 2023-06, Vol.47 (6), p.338-344
• Main Authors: Villarreal, E., Ramírez, P., Gordon, M., Vicent, C., Gómez, M.D., de Hevia, L., Vacacela, K., Alonso, R., Vila, J.
• Format: Article
• Language: English
• Subjects: Bacterias gramnegativas; Cardiogenic shock; Endotoxin; Endotoxina; Endotoxins; Gram-negative bacteria; Humans; Immunoglobulin M; Pathophysiology; Patofisiología; Prospective Studies; Septic shock; Shock cardiogénico; Shock séptico; Shock, Cardiogenic; Shock, Septic
• ISSN: 0210-5691; 2173-5727
• DOI: 10.1016/j.medin.2022.04.005

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. Prospective, observational non intervention study. Critical Care Department of a University tertiary hospital. Cardiogenic shock (CS) and septic shock (SS) patients. None. 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). 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. En el paciente crítico se ha descrito una actividad incrementada de la endotoxina no asociada a infección por bacterias gramnegativas (BGN). La gravedad de la enfermedad influye en este fenómeno, por ello realizamos este estudio en el paciente crítico por antonomasia: shock séptico y cardiogénico. Estudio prospectivo, observacional, sin intervención. Unidad de Cuidados Intensivos. Pacientes en shock cardiogénico (SC) o séptico (SS). Ninguna. Seguimiento durante los 3 primeros días. Proteína C reactiva, procalcitonina e interleucina-6, y el título de anticuerpos IgM anti-edotoxina (IgM EndoCAb) se analizaron diariamente. Se incluyó a 62 pacientes; 25 con SS y 37 con SC. La etiología fue identificada en 23 pacientes con SS (92%), los BGN estuvieron presentes en 13 cas