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Open Access 01-12-2018 | Research

Relationship between endotoxin core, staphylococcal and varicella antibody levels and outcome following aortic valve replacement surgery: a prospective observational study

Authors: Andrew Smith, Sarka Moravcova, Thomas A. Treibel, Patricia Colque-Navarro, Roland Mollby, James C. Moon, Colin Hamilton-Davies

Published in: Perioperative Medicine | Issue 1/2018

Abstract

Background

Morbidity and mortality following cardiac valve surgery is high. Immunity is an important contributor to outcome. This study examines the relationship of staphylococcal and endotoxin antibody levels to outcome following cardiac surgery.

Methods

Using enzyme-linked immunosorbent assays (ELISA), we measured pre-operative levels of antibodies to endotoxin core (EndoCAb); 3 common staphylococcal epitopes and varicella on saved serum of 60 adult patients scheduled to undergo elective primary surgical aortic valve replacement (AVR). Primary outcome measure was post-operative length of stay (LOS) in hospital with secondary outcomes being development of infective complications, length of stay on the intensive care unit (ICU) and 30-day mortality. Patients were quartiled according to antibody levels and outcomes compared between the quartile groups using Mann-Whitney tests for length of stay and Fisher’s test for development of infection.

Results

Sixty patients (34 M, 26 F) were recruited with mean age 73 years (IQR 66–78), mean body mass index (BMI) 27.7 (IQR 25–31) and EuroSCORE II 1.44 (0.95–1.99). Those patients in the lower quartile for pre-operative antibody level had a longer post-operative stay than the upper quartile. EndoCAb (median IgG level Q1 42.2 MU/ml vs Q4 256 MU/ml) 9 vs 6 days, p = 0.025; alpha-toxin (median IgG level Q1 63 U vs Q4 558 U) 10 vs 7 days, p = 0.034; teichoic acid (median IgG level Q1 14 U vs Q4 419 U) 10 vs 8 days, p = 0.441; staphylococcal enterotoxin A (median IgG level Q1 55 U vs Q4 427 U) 9 vs 7 days, p = 0.865; varicella zoster (median IgG level Q1 1.325 U vs Q4 2.54 U) 8 vs 7 days, p = 1.0; and combined antibody levels 10 vs 6 days, p = 0.017. There were no differences in the number developing post-operative infections for each antibody type. The combined antibody analysis suggested a reduction in proportion of individuals developing infection from the upper vs lower quartile: 0 vs 0.33, p = 0.042.

Conclusions

This study again suggests the inverse relationship between endotoxin core antibody levels and outcome following aortic valve surgery as well as suggesting a similar relationship with antibodies to staphylococcus. There is no such relationship for antibody levels against an organism not providing a peri-operative threat. Understanding this relationship may enable therapeutic manipulation of immune status, re-evaluation of risk and further investigation of the low immune state.

Trial registration

The patients in this study are a sub-group of the RELIEF AS study.

ClinicalTrials.gov identifier NCT02174471.

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Title: Relationship between endotoxin core, staphylococcal and varicella antibody levels and outcome following aortic valve replacement surgery: a prospective observational study
Authors: Andrew Smith
Sarka Moravcova
Thomas A. Treibel
Patricia Colque-Navarro
Roland Mollby
James C. Moon
Colin Hamilton-Davies
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Perioperative Medicine / Issue 1/2018
Electronic ISSN: 2047-0525
DOI: https://doi.org/10.1186/s13741-018-0101-z

Keynote webinar | Spotlight on medication adherence

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Relationship between endotoxin core, staphylococcal and varicella antibody levels and outcome following aortic valve replacement surgery: a prospective observational study

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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