Levels of Antibodies to Endotoxin and Cytokine Release in Patients with Severe Trauma

Pape, Hans-Christian; Remmers, D.; Grotz, M.; Schedel, I.; Gliński, S; Oberbeck, Reiner; Dahlweit, M.; Tscherne, H.

doi:10.1097/00005373-199905000-00022

Cited by 55 publications

(29 citation statements)

References 24 publications

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“…In addition, this effect may have been because of our improved diagnostic abilities regarding chest injuries. Numerous studies have demonstrated that accurate grading of the severity of thoracic trauma 48,49 and the prediction of later complications 50,51 is difficult. Moreover, if pulmonary contusions are present, their dynamic nature is well known.…”

Section: Influence Of Damage Control Orthopedics After Blunt Polytraumamentioning

confidence: 99%

Changes in the Management of Femoral Shaft Fractures in Polytrauma Patients: From Early Total Care to Damage Control Orthopedic Surgery

Pape

Hildebrand

Pertschy

et al. 2002

The Journal of Trauma: Injury, Infection, and Critical Care

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314

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Section: Influence Of Damage Control Orthopedics After Blunt Polytraumamentioning

confidence: 99%

Changes in the Management of Femoral Shaft Fractures in Polytrauma Patients: From Early Total Care to Damage Control Orthopedic Surgery

Pape

Hildebrand

Pertschy

et al. 2002

The Journal of Trauma: Injury, Infection, and Critical Care

Self Cite

314

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“…This endogenous response may guarantee that most of the multiple trauma patients survive despite endotoxemia. In fact, it has been demonstrated that if patients with severe trauma show an only low production of anti-endotoxin antibodies, they have a significantly higher risk of death due to MOF (6). Accordingly, we speculate that in those patients the application of anti-endotoxin antibodies or other antiendotoxin treatment strategies, such as LPS absorption or binding, should exert beneficial results, reducing the development of MOF and improving the survival rate.…”

mentioning

confidence: 86%

“…LPS is a potent trigger of the innate immunity, inducing a massive activation of PMN leukocytes and macrophages, which results in an overwhelming proinflammatory cytokine response (5,6). Of interest, endotoxin has also been suggested as the trigger of a complex cascade of inflammation in the development of MOF and death after multiple traumas (7).…”

mentioning

confidence: 99%

Déjà-vu from the nineties: is there a perspective for anti-endotoxin strategies to improve the outcome of multiple trauma patients?

Histing

Menger

2016

J. Thorac. Dis.

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A recent cohort study of Charbonney et al. indicates that multiple trauma patients develop endotoxemia also in the absence of Gram-negative infection. This is most probably due to an increase of gut permeability. Non-survivors as well as patients with cardiovascular dysfunction and multiple organ failure (MOF) show significantly higher endotoxin levels at 24 h after injury compared to survivors and patients without MOF. These results are like a déjà-vu from the nineties of the last century, where several studies reported endotoxemia during the initial 24 h after multiple trauma with development of MOF and death at endotoxin levels >10 and >12 pg/mL, respectively. Of interest, other multiple trauma patient studies in the nineties have shown endogenous anti-endotoxin antibody production in survivors and reduced antibody production in non-survivors, which died from MOF. Although all these studies have pointed towards a mechanistic role of endotoxin in the fatal outcome after multiple injuries, clinical anti-endotoxin studies are still lacking. Thus, the future perspective must be prospective randomized multicenter trials, which have to elucidate the capability of anti-endotoxin treatment strategies to improve outcome in multiple trauma patients.

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“…EndoCAb levels decreased in nonsurvivors as a result of sepsis, 33 and in patients with severe trauma, leading to multiple organ failure. 34 Mythen et al 11 showed decreased…”

Section: Gut Barrier Function and Multiple Organ Dysfunctionmentioning

confidence: 99%

Barrier Function of the Gut and Multiple Organ Dysfunction after Cardiac Surgery

Bühner

Kastrup

et al. 2007

J Int Med Res

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72We studied the influence of sequential involvement of the gastrointestinal (GI) tract on the development of multiple organ dysfunction (MOD) after cardiopulmonary bypass (CPB). One hundred and forty-six patients undergoing elective cardiac surgery were included in this prospective observational study. Standardized oral inert-sugar tests (sucrose, lactulose, mannitol, sucralose) were performed before and after CPB in different patients. Enzyme-linked immunosorbent assay of plasma levels of endotoxin core antibodies (EndoCAb) were performed peri-operatively. The functional mucosal surface was calculated from the amount of mannitol absorbed from the GI tract. Lower urine concentrations of absorbed mannitol were observed preoperatively in patients developing MOD. In binary logistic regression this was an independent parameter. Decreased plasma concentrations of EndoCAb after surgery were seen in every patient, but were more significant in patients developing MOD. A reduced pre-operative functional mucosal surface may predict the early occurrence of MOD after surgery.

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Levels of Antibodies to Endotoxin and Cytokine Release in Patients with Severe Trauma

Cited by 55 publications

References 24 publications

Changes in the Management of Femoral Shaft Fractures in Polytrauma Patients: From Early Total Care to Damage Control Orthopedic Surgery

Changes in the Management of Femoral Shaft Fractures in Polytrauma Patients: From Early Total Care to Damage Control Orthopedic Surgery

Déjà-vu from the nineties: is there a perspective for anti-endotoxin strategies to improve the outcome of multiple trauma patients?

Barrier Function of the Gut and Multiple Organ Dysfunction after Cardiac Surgery

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