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. 2003 Aug;238(2):258-63.
doi: 10.1097/01.sla.0000082711.77096.71.

Influence of modest endotoxemia on postoperative antithrombin deficiency and circulating secretory immunoglobulin a levels

Tetsuji Fujita  1 , Takashi Imai, Sadao Anazawa
Affiliations

Influence of modest endotoxemia on postoperative antithrombin deficiency and circulating secretory immunoglobulin a levels

Tetsuji Fujita et al. Ann Surg. 2003 Aug.

Abstract

Objective: To evaluate the influence of modest endotoxemia on postoperative antithrombin deficiency and cholestasis.

Summary background data: It has not been determined whether endotoxin translocation in small amounts is a physiological phenomenon or whether it is a potential health hazard.

Methods: Blood endotoxin, antithrombin III (ATIII), secretory immunoglobulin A (sIgA), which was selected as a marker of cholestasis, C-reactive protein (CRP), and alpha-1-antitrypsin (AAT) concentrations were measured from the 20 patients undergoing curative gastrectomy for gastric cancer preoperatively and postoperatively. Portal and systemic blood samples were taken for the analysis of endotoxin and interleukin-6 (IL-6) concentrations during surgery in these patients.

Results: Although plasma endotoxin levels showed a significant increase during surgery, we did not find a correlation with ATIII, sIgA, CRP, and IL-6 levels. Systemic blood endotoxin levels during surgery correlated with a postoperative rise of serum AAT levels. Plasma ATIII levels transiently decreased on the first and third postoperative day, and sIgA levels were shown to increase on the seventh postoperative day. There was a weak relationship between the extent of postoperative endotoxemia and a reduction in ATIII concentrations.

Conclusions: The influence of modest endotoxemia on postoperative antithrombin deficiency and cholestasis was limited, and increased translocational endotoxemia during abdominal surgery may be a physiological phenomenon to trigger off an acute-phase protein response.

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Figures

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FIGURE 1. Distribution of all data with mean SD are shown. Circulating endotoxin concentrations were significantly (P < 0.01) increased during surgery and returned to almost preoperative values 24 hours after operation. OP, operation; POD, postoperative day.
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FIGURE 2. The extent of endotoxemia during surgery correlated with the subsequent rise in serum α-1-antitrypsin levels.
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FIGURE 3. Changes in antithrombin III and secretory IgA levels. Antithrombin III levels were significantly reduced after surgery, whereas secretory IgA levels were increased on the seventh postoperative day. Values are mean or SD. OP, operation; POD, postoperative day. *, P < 0.05; **, P < 0.01.
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FIGURE 4. There was a weak relationship between postoperative endotoxin concentrations and antithrombin III deficiency.
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