Skip to main content

Regional variation in anti-endotoxin core antibody levels in healthy and preoperative surgical populations


Endotoxin has a central role in sepsis and organ dysfunction after surgery. Levels of one of our natural defences against endotoxin, antibodies to endotoxin core (EndoCAb), are independent predictors of postoperative outcome [1]. There is a heterogeneity in EndoCAb levels between European and North American healthy donor populations that remains unexplained [2].


Blood samples from healthy blood donors were collected in London, UK and compared with levels of baseline EndoCAb in previous studies. An ELISA assay of serum EndoCAb IgG (n = 165) and IgM (n = 65*) levels was performed and expressed as median units per ml (MU/ml) [3].


The median serum EndoCAb IgG and IgM levels in this population were 189.7 (41.8–1023) MU/ml and 222.5 (42.3–913.9) MU/ml, respectively (Fig. 1).

figure 1

Figure 1


EndoCAb levels are higher in London healthy donors than in the Scottish population. US cardiac patients show higher IgG levels than UK cardiac patients and Scottish healthy donors, but are similar to London healthy donors. US surgery patients show higher IgM levels than all groups but are similar to London healthy donors. Differences may be due to prior exposure to endotoxin, different disease process, differences in sampling and patient management, or genetic variation between countries. We are collecting further healthy donor samples to assess a larger cohort of EndoCAb levels in London.


  1. Bennett-Guerrero E, Panah MH, Barclay GR, Bodian CA, Winfree WJ, Andres LA, Reich DL, Mythen MG: Decreased endotoxin immunity is associated with greater mortality and/or prolonged hospitalization after surgery. Anesthesiology 2001, 94: 992-998. 10.1097/00000542-200106000-00012

    CAS  Article  PubMed  Google Scholar 

  2. Grocott , et al.: [Abstract]. Br J Anesth 1999, 82: 170.

    Article  Google Scholar 

  3. Barclay GR, Scott BB: Serological relationship between Escherichia coli and Salmonella smooth- and rough-mutant lipopolysaccharides as revealed by enzyme-linked immunosorbent assay for human immunoglobulin G antien-dotoxin antibodies. Infect Immun 1987, 55: 2706-2714.

    PubMed Central  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Rights and permissions

Reprints and Permissions

About this article

Cite this article

Rashid, M., Stephens, R., Siva, M. et al. Regional variation in anti-endotoxin core antibody levels in healthy and preoperative surgical populations. Crit Care 7, P199 (2003).

Download citation

  • Published:

  • DOI:


  • Healthy Donor
  • Cardiac Patient
  • Median Serum
  • Healthy Blood Donor
  • Median Unit