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Alkaline Phosphatase Activity and Endotoxemia After Infant Cardiothoracic Surgery.

Publication ,  Journal Article
Davidson, JA; Urban, TT; Tong, S; Maddux, A; Hill, G; Frank, BS; Watson, JD; Jaggers, J; Simões, EAF; Wischmeyer, P
Published in: Shock
March 2019

OBJECTIVE: Infant cardiopulmonary bypass (CPB) increases intestinal permeability leading to endotoxemia. Alkaline phosphatase (AP) reduces endotoxin toxicity in vitro but its effects on endotoxemia in human disease are poorly understood. We assessed the association between serum AP activity and endotoxemia in infants undergoing CPB and determined the effect of ex vivo addition of AP on endotoxemia. METHODS: Prospective cohort study of 62 infants ≤120 days of age undergoing CPB. AP activity and Endotoxin Activity Assay (EAA) were measured pre-operatively, during rewarming, and 24 h after cardiac intensive care unit admission. In 22 subjects, EAA was measured in pre-operative and rewarming whole blood samples with/without addition of 1,600 U/L of human liver AP. RESULTS: AP activity decreased during CPB (mean decrease 94.8U/L; P < 0.0001). Median EAA was 0.41 pre-operation, rose to 0.52 (P < 0.05) during rewarming, and remained stably elevated at 24 h. Subjects with low pre-operative AP activity had significantly higher pre-operative (0.47 vs. 0.36; P < 0.05) and rewarming (0.59 vs. 0.43; P < 0.01) EAA with a trend toward higher EAA at 24 h (0.52 vs. 0.45; P = 0.12). Subjects with low rewarming AP activity showed similar differences that did not reach statistical significance. Ex vivo addition of human liver AP decreased pre-operative EAA by 29% (P < 0.001) and rewarming EAA by 51% (P < 0.0001). CONCLUSION: Endotoxemia is common in infants undergoing CPB. Native AP activity and endotoxemia are inversely related and ex vivo addition of exogenous AP reduces whole blood EAA. Future research should evaluate AP as a therapy to reduce the harmful effects of endotoxemia following infant CPB.

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Published In

Shock

DOI

EISSN

1540-0514

Publication Date

March 2019

Volume

51

Issue

3

Start / End Page

328 / 336

Location

United States

Related Subject Headings

  • Time
  • Prospective Studies
  • Postoperative Complications
  • Male
  • Infant, Newborn
  • Infant
  • Humans
  • Female
  • Endotoxins
  • Endotoxemia
 

Citation

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Chicago
ICMJE
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Davidson, J. A., Urban, T. T., Tong, S., Maddux, A., Hill, G., Frank, B. S., … Wischmeyer, P. (2019). Alkaline Phosphatase Activity and Endotoxemia After Infant Cardiothoracic Surgery. Shock, 51(3), 328–336. https://doi.org/10.1097/SHK.0000000000001162
Davidson, Jesse A., Tracy T. Urban, Suhong Tong, Aline Maddux, Gerald Hill, Benjamin S. Frank, John D. Watson, James Jaggers, Eric A. F. Simões, and Paul Wischmeyer. “Alkaline Phosphatase Activity and Endotoxemia After Infant Cardiothoracic Surgery.Shock 51, no. 3 (March 2019): 328–36. https://doi.org/10.1097/SHK.0000000000001162.
Davidson JA, Urban TT, Tong S, Maddux A, Hill G, Frank BS, et al. Alkaline Phosphatase Activity and Endotoxemia After Infant Cardiothoracic Surgery. Shock. 2019 Mar;51(3):328–36.
Davidson, Jesse A., et al. “Alkaline Phosphatase Activity and Endotoxemia After Infant Cardiothoracic Surgery.Shock, vol. 51, no. 3, Mar. 2019, pp. 328–36. Pubmed, doi:10.1097/SHK.0000000000001162.
Davidson JA, Urban TT, Tong S, Maddux A, Hill G, Frank BS, Watson JD, Jaggers J, Simões EAF, Wischmeyer P. Alkaline Phosphatase Activity and Endotoxemia After Infant Cardiothoracic Surgery. Shock. 2019 Mar;51(3):328–336.

Published In

Shock

DOI

EISSN

1540-0514

Publication Date

March 2019

Volume

51

Issue

3

Start / End Page

328 / 336

Location

United States

Related Subject Headings

  • Time
  • Prospective Studies
  • Postoperative Complications
  • Male
  • Infant, Newborn
  • Infant
  • Humans
  • Female
  • Endotoxins
  • Endotoxemia