PLASMA-CONCENTRATIONS OF ENDOTOXIN AND ANTIENDOTOXIN ANTIBODIES IN PATIENTS WITH MULTIPLE INJURIES - A PROSPECTIVE CLINICAL-STUDY

Objective: To investigate the time course of endotoxaemia and its effe cts on the synthesis of antiendotoxin antibodies in patients with mult iple injuries. Design: Prospective clinical study. Setting: University hospital, Germany. Patients: 40 Patients with multiple injuries and 2 0 healthy volunteers who served as controls. Interventions: Blood samp les were collected up to 10 days after injury and the concentrations o f endotoxin, antiendotoxin antibodies to four endotoxins, and for anti -alpha-haemolysin of Staphylococcus aureus were measured. The kinetics of endotoxaemia and antiendotoxin antibodies were investigated. Resul ts: Endotoxaemia peaked 0-3 hours after injury at 0.425 EU/ml and decr eased thereafter to 0.04 EU/ml within five days. Total concentrations of IgM, IgA, and IgG increased continuously after day 3 (p < 0.05), bu t the specific IgM response to all endotoxins was only temporary and t he relative content of specific antibodies to all endotoxins peaked at day 3 (p < 0.05). Antiendotoxin antibodies of IgM class cross-reacted among themselves. There was no general increase in specific antiendot oxin antibodies of IgA and IgG class. The relative content of specific antibodies to cc-haemolysin of S aureus of all classes of immunoglobu lins (IgM, IgA, IgG) remained on the same level from day 0-10. Conclus ion: Multiple injuries are associated with early and temporary endotox aemia which causes specific increases in antiendotoxin antibodies of t he IgM-class. IgM antibodies to endotoxins cross-react among themselve s.