ArticleCritical care (London, England)2011
Endotoxemia related to cardiopulmonary bypass is associated with increased risk of infection after cardiac surgery: a prospective observational study.
Article in Critical care (London, England), 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed, 50 citations in OpenAlex.
- Trial
- The Gut Microbiome in Congenital Heart Disease: Dysbiosis, Intestinal Barrier Injury, and Translational Opportunities Across the Childhood-A Narrative Review.Children (Basel, Switzerland) · 2026Review
- Impact of early β-blocker use on the incidence of sepsis and clinical outcomes following cardiac surgery: a retrospective cohort study.Frontiers in pharmacology · 2025Article
- Gaps and opportunities in sepsis translational research.EBioMedicine · 2022Review
- A pilot study of an anti-endotoxin Ig-enriched bovine colostrum to prevent experimental sepsis.Innate immunity · 2021Article
- Increased Phospholipid Transfer Protein Activity Is Associated With Markers of Enhanced Lipopolysaccharide Clearance in Human During Cardiopulmonary Bypass.Frontiers in cardiovascular medicine · 2021Article
- Observational
- Infant cardiopulmonary bypass: CD73 kinetics, association with clinical outcomes, and influence on serum adenosine production capacity.Pediatric research · 2018Article
- The preventive effects of dexmedetomidine on endotoxin-induced exacerbated post-incisional pain in rats.Journal of anesthesia · 2017Article
- Klotho suppresses the inflammatory responses and ameliorates cardiac dysfunction in aging endotoxemic mice.Oncotarget · 2017Article
- Influence of hypothermia and subsequent rewarming upon leukocyte-endothelial interactions and expression of Junctional-Adhesion-Molecules A and B.Scientific reports · 2016Article
- A single preoperative FGF23 measurement is a strong predictor of outcome in patients undergoing elective cardiac surgery: a prospective observational study.Critical care (London, England) · 2015Observational
- Polymyxin B hemoperfusion: a mechanistic perspective.Critical care (London, England) · 2014Review
- Prevention of infectious complications after heart surgery in children: procalcitonin-guided strategy.Kardiochirurgia i torakochirurgia polska = Polish journal of cardio-thoracic surgery · 2014Article
- Bench-to-bedside review: Clinical experience with the endotoxin activity assay.Critical care (London, England) · 2012Review
- Alkaline phosphatase activity after cardiothoracic surgery in infants and correlation with post-operative support and inflammation: a prospective cohort study.Critical care (London, England) · 2012Observational
- Narrative review of systemic inflammatory response mechanisms in cardiac surgery and immunomodulatory role of anesthetic agents.Annals of cardiac anaesthesiaReview
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionPrevious studies have documented a high frequency of endotoxemia associated with cardiopulmonary bypass (CPB). Endotoxemia may be responsible for some of the complications associated with cardiac surgery. The purpose of the study was to examine the prevalence of endotoxemia during cardiopulmonary bypass supported aortocoronary bypass grafting surgery (ACB) using a new assay, the Endotoxin Activity Assay (EAA), and explore the association between endotoxemia and post-operative infection.
methodsThe study was a single center prospective observational study measuring EAA during the perioperative period for elective ACB. Blood samples were drawn at induction of anesthesia (T1), immediately prior to release of the aortic cross-clamp (T2), and on the first post-operative morning (T3). The primary outcome was the prevalence of endotoxemia. Secondary outcomes assessed included infection rates, intensive care unit (ICU) and hospital length of stay. An EAA of < 0.40 units was interpreted as "low", 0.41 to 0.59 units as "intermediate", and ≥ 0.60 units as "high".
resultsA total of 57 patients were enrolled and 54 patients were analyzable. The mean EAA at T1 was 0.38 +/- 0.14, at T2 0.39 +/- 0.18, and at T3 0.33 +/- 0.18. At T2 only 13.5% (7/52) of patients had an EAA in the high range. There was a positive correlation between EAA and duration of surgery (P = 0.02). In patients with EAA ≥ 0.40 at T2, 26.1% (6/23) of patients developed post-operative infections compared to 3.5% (1/29) of those that had a normal EAA (P = 0.0354). Maximum EAA over the first 24 hours was also strongly correlated with risk of post-operative infection (P = 0.0276).
conclusionsHigh levels of endotoxin occur less frequently during ACB than previously documented. However, endotoxemia is associated with a significantly increased risk of the development of post-operative infection. Measuring endotoxin levels during ACB may provide a mechanism to identify and target a high risk patient population.
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