Key result
Low endotoxemia incidence in cardiogenic shock suggests targeted rather than unselected endotoxemia-directed therapy.
Why the study?
Evidence regarding endotoxemia in acute heart failure and cardiogenic shock may be overlooked, mechanisms remain incompletely understood, and there are no established indications to treat endotoxemia despite available therapeutics.
Due to a lack of direct evidence and low reported incidence, treatments targeting endotoxemia in acute heart failure and cardiogenic shock require a personalized approach identifying patients with significant endotoxin burden.
Answers are grounded in this paper and cite their sources.
Endotoxemia-targeted therapies warrant caution in unselected cardiogenic shock; leaves open biomarker-guided trials to define responsive subgroups.
Acute heart failure and cardiogenic shock are frequently occurring and deadly conditions. In patients with those conditions, endotoxemia related to gut injury and gut barrier dysfunction is usually described as a driver of organ dysfunction. Because endotoxemia might reciprocally alter cardiac function, this phenomenon has been suggested as a potent vicious cycle that worsens organ perfusion and leading to adverse outcomes. Yet, evidence beyond this phenomenon might be overlooked, and mechanisms are not fully understood. Subsequently, even though therapeutics available to reduce endotoxin load, there are no indications to treat endotoxemia during acute heart failure and cardiogenic shock. In this review, we first explore the evidence regarding endotoxemia in acute heart failure and cardiogenic shock. Then, we describe the main treatments for endotoxemia in the acute setting, and we present the challenges that remain before personalized treatments against endotoxemia can be used in patients with acute heart failure and cardiogenic shock.
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Nguyen et al. (2023) conducted a review in Acute heart failure and cardiogenic shock. Therapies targeting endotoxemia was evaluated. Despite the paradigm of gut-derived endotoxemia, the reported incidence in cardiogenic shock appears low, suggesting that treatments targeting endotoxemia should be personalized rather than given to unselected patients.
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