• Paula Ramirez, Esther Villarreal, Monica Gordon, María Dolores Gómez, Luis de Hevia, Karla Vacacela, Teresa Gisbert, Adrian Quinzá, Jesús Ruiz, Ricardo Alonso, Juan Bonastre, and Jordi Vila.
• *Critical Care Department, University Hospital la Fe, Valencia †Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Carlos III Research Institute, Madrid ‡Microbiology Department, University Hospital la Fe §Laboratory Department, University Hospital la Fe, Valencia ||Department of Microbiology, Hospital Clinic, IDIBAPS, School of Medicine, University of Barcelona, Barcelona, Spain.
• Shock. 2017 May 1; 47 (5): 588-592.

ObjectiveIn cardiogenic shock (CS), presence of fever, leukocytosis, relatively low systemic vascular resistances, and high serum procalcitonin levels are quite frequent and recurrently involve the search for an infectious complication. We hypothesized that endotoxin exposure in CS could explain this sepsis-like syndrome.Design And SettingProspective observational study of consecutive CS patients admitted to our intensive care unit (ICU). Patients were followed during the first 3 days after CS onset. All clinical, hemodynamic, and microbiological data were collected. Inflammatory biomarkers and anti-endotoxin antibodies (IgM EndoCAb) were daily measured.PatientsWe included 37 consecutive CS patients.Measurements And Main ResultsTwenty-two patients (60%) had body temperature >38.3°C or <35°C; and 23 patients (62%) had a leucocyte count >14,000/mm or <4,000/mm. Microbiological study was performed in 30 patients (81%). No infection was diagnosed in the studied patients. All the patients had serum inflammatory biomarkers levels above normal values including procalcitonin (19 patients [51%] had serum procalcitonin above 2 ng/mL). All the patients had IgM EndoCAb below the normal median value; 22 patients (59.5%) had IgM anti-endotoxin value below 10th percentile range for healthy people. Hemodynamic and respiratory stabilization was achieved in 23 patients (62%) and the ICU mortality rate was 38%, only procalcitonin and interleuquin-6 were associated with higher mortality rate.ConclusionWe have detected extremely low titers of IgM EndoCAb in CS suggesting endotoxin exposure. However, only inflammatory biomarkers were related to ICU mortality.

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