Impaired endotoxin inactivation, rather than gut translocation, is associated with organ injury in cardiac surgery with cardiopulmonary bypass: An ancilliary analysis of a randomised control trial.
Maxime Nguyen, Marvin Alvarez, Corentin Evezard et al.
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In 30 seconds
This ancillary analysis of a randomised controlled trial examined endotoxin mass and activity in adults undergoing cardiac surgery with expected cardiopulmonary bypass (CPB) longer than 90 minutes, and assessed intra-operative haemoadsorption. Across 295 samples from 66 patients, CPB was followed by lower endotoxin mass but relatively higher activity. Higher postoperative endotoxin activity was associated with intra-operative dobutamine requirement, increased inflammatory biomarkers and organ injury. Endotoxin mass and activity were not lower with haemoadsorption than with standard care, suggesting that impaired endotoxin inactivation, rather than greater endotoxin quantity, may relate to harm.
Key findings
- The analysis included 295 samples from 66 adults undergoing cardiac surgery with prolonged CPB.
- After CPB, endotoxin mass decreased while endotoxin activity increased relatively.
- Higher postoperative endotoxin activity was associated with dobutamine requirement, increased inflammatory biomarkers and organ injury.
- Endotoxin plasma mass and activity were not lower in patients receiving haemoadsorption.
Why it matters
The findings distinguish endotoxin activity from its measured mass: the biological activity remaining after CPB was associated with inflammatory and organ-injury outcomes, whereas endotoxin quantity alone may not capture this relationship. This supports further attention to endotoxin inactivation as a potential mechanism in postoperative inflammation, while the observed associations do not establish causality.
What to keep in mind
This was an ancillary analysis, and the reported associations do not establish that endotoxin activity caused organ injury.