LIPOPOLYSACCHARIDE-REACTIVE IMMUNOGLOBULIN-E IS ASSOCIATED WITH LOWERMORTALITY AND ORGAN FAILURE IN TRAUMATICALLY INJURED PATIENTS

Antilipopolysaccharide (anti-LPS) immunoglobulin G (IgG) and IgM have been associated with protection from LPS effects in vivo. We investiga ted the presence of IgE and anti-LPS in 32 patients that had experienc ed severe traumatic injury and in 35 healthy volunteers; we also inves tigated whether IgE anti-LPS was associated with important clinical ev ents. Plasma samples were collected daily from patients in the intensi ve care unit and on one occasion from volunteers; the samples were ass ayed for IgE anti-LPS. IgE anti-LPS was assayed by enzyme-linked immun osorbent assay with monoclonal anti-human IgE as the capture antibody. Detection was accomplished with biotin-labeled LPS (Escherichia coli J5 mutant) followed by streptavidin-peroxidase with 2,2'-azino(3-ethyl benzthiazoline)sulfonic acid as the substrate. The assay was demonstra ted to be specific for IgE and LPS-biotin by nonreactivity of control sera with high-titer anti-LPS IgG and IgM and by inhibition with unlab eled LPS. IgE anti-LPS was detected in 1 of 35 healthy controls (2.9%) and 25 of 32 traumatically injured patients (78%) (P < 0.001). The pr esence of IgE anti-LPS was associated with a lower incidence of death (P = 0.026) and of renal failure (P = 0.0012). There was no apparent t emporal relationship between detection of IgE anti-LPS and clinical ev ents. IgG anti-LPS was detected more frequently in patients that were positive for IgE anti-LPS (P = 0.06) but was not associated with clini cal events. The inability to detect IgE anti-LPS may be related to adv erse clinical events through depletion of specific IgE due to LPS expo sure after trauma or through saturation of the assay by IgE with other specificities. We have reported increased total IgE concentrations in these patients (J. T. DiPiro, R. G. Hamilton, T. R. Howdieshell, N. F . Adkinson, and A. R. Mansberger, Ann. Surg. 215:460-466, 1992).