AUTHOR=Payen Didier , Dupuis Claire , Deckert Valérie , Pais de Barros Jean-Paul , Rérole Anne-Laure , Lukaszewicz Anne-Claire , Coudroy Remi , Robert René , Lagrost Laurent 

TITLE=Endotoxin Mass Concentration in Plasma Is Associated With Mortality in a Multicentric Cohort of Peritonitis-Induced Shock

JOURNAL=Frontiers in Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.749405

DOI=10.3389/fmed.2021.749405

ISSN=2296-858X

ABSTRACT=<p><bold>Objectives:</bold> To investigate the association of plasma LPS mass with mortality and inflammation in patients with peritonitis-induced septic shock (SS).</p><p><bold>Design:</bold> Longitudinal endotoxin and inflammatory parameters in a multicentric cohort of SS.</p><p><bold>Patients:</bold> Protocolized post-operative parameters of 187 SS patients collected at T1 (12 h max post-surgery) and T4 (24 h after T1).</p><p><bold>Intervention:</bold><italic>Post-hoc</italic> analysis of ABDOMIX trial.</p><p><bold>Measurements and Results:</bold> Plasma concentration of LPS mass as determined by HPLC-MS/MS analysis of 3-hydroxymyristate, activity of phospholipid transfer protein (PLTP), lipids, lipoproteins, IL-6, and IL-10. Cohort was divided in low (LLPS) and high (HLPS) LPS levels. The predictive value for mortality was tested by multivariate analysis. HLPS and LLPS had similar SAPSII (58 [48.5; 67]) and SOFA (8 [6.5; 9]), but HLPS showed higher death and LPS to PLTP ratio (<italic>p</italic> &lt; 0.01). LPS was stable in HLPS, but it increased in LLPS with a greater decrease in IL-6 (<italic>p</italic> &lt; 0.01). Dead patients had a higher T1 LPS (<italic>p</italic> = 0.02), IL-6 (&lt;0.01), IL-10 (=0.01), and day 3 SOFA score (<italic>p</italic> = 0.01) than survivors. In the group of SAPSII &gt; median, the risk of death in HLPS (38%) was higher than in LLPS (24%; <italic>p</italic> &lt; 0.01). The 28-day death was associated only with SAPSII (OR 1.06 [1.02; 1.09]) and HLPS (OR 2.47 [1; 6.11]) in the multivariate model. In HLPS group, high PLTP was associated with lower plasma levels of IL-6 (<italic>p</italic> = 0.02) and IL-10 (<italic>p</italic> = 0.05).</p><p><bold>Conclusions:</bold> Combination of high LPS mass concentration and high SAPS II is associated with elevated mortality in peritonitis-induced SS patients.</p>