Kim Hye Sung, Lee Gyeo Ra, Kim Eun Young
Division of Trauma and Surgical Critical Care, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Biomedicines. 2024 Nov 26;12(12):2701. doi: 10.3390/biomedicines12122701.
: Endotoxin, a component of lipopolysaccharide (LPS) from bacteria, disrupts the immune system, potentially leading to multiorgan failure. Unlike previous studies, we enrolled patients with mild clinical conditions after major abdominal surgery and assessed the predictive value of endotoxin activity (EA) levels for acute complications which occur within 7 days postoperatively. Also, the differential diagnostic value of EA was assessed in a subgroup of patients with abnormal liver function during the immediate postoperative period. : Patients admitted to the surgical ICU of our institution following elective abdominal surgery were enrolled. Participants were classified into low/high postoperative EA groups based on EA cutoff values for predicting complications. Additionally, participants were categorized based on liver function assessed at ICU admission using total bilirubin (TB) levels. Abnormal liver function was defined as a TB level > 1.2 mg/dL. : 86 patients were analyzed. The EA cutoff for postoperative complications was 0.485, with 49 patients (57%) categorized in the low EA group (EA levels < 0.485) and 37 patients (43%) in the high EA group (EA levels ≥ 0.485). The high EA group experienced statistically worse outcomes, including longer ICU stays and higher mortality rates. Logistic regression analysis confirmed that EA levels and SOFA scores were significant predictors of postoperative complications. For patients with elevated TB, the EA cutoff value for postoperative complications was 0.515, which is higher than those obtained for the total patient cohort. : EA level is a viable surveillance tool for detecting postoperative complications in the acute period among ICU patients undergoing major abdominal surgery, and must be interpreted carefully considering the patient's liver function.
内毒素是细菌脂多糖（LPS）的一种成分，会破坏免疫系统，可能导致多器官功能衰竭。与以往研究不同，我们纳入了腹部大手术后临床症状较轻的患者，并评估了内毒素活性（EA）水平对术后7天内发生的急性并发症的预测价值。此外，还在术后即刻肝功能异常的患者亚组中评估了EA的鉴别诊断价值。
我们纳入了在我院外科重症监护病房（ICU）接受择期腹部手术后入院的患者。根据预测并发症的EA临界值，将参与者分为术后EA低/高组。此外，根据ICU入院时使用总胆红素（TB）水平评估的肝功能对参与者进行分类。肝功能异常定义为TB水平>1.2mg/dL。
对86例患者进行了分析。术后并发症的EA临界值为0.485，49例患者（57%）被归类为EA低组（EA水平<0.485），37例患者（43%）被归类为EA高组（EA水平≥0.485）。EA高组的预后在统计学上更差，包括ICU住院时间更长和死亡率更高。逻辑回归分析证实，EA水平和序贯器官衰竭评估（SOFA）评分是术后并发症的重要预测指标。对于TB升高的患者，术后并发症的EA临界值为0.515，高于整个患者队列的临界值。
EA水平是检测接受腹部大手术的ICU患者急性期术后并发症的可行监测工具，并且在考虑患者肝功能的情况下必须谨慎解读。
