Post-operative circulating cytokine patterns--the influence of infection.
OBJECTIVE
To study post-operative plasma concentrations of tumor necrosis factor alpha (TNF), interleukin-1 beta (IL-1) and interleukin-6 (IL-6) in infected and non-infected patients.


METHODS
Prospective controlled clinical study.


METHODS
The intensive care unit (ICU) of a university hospital.


METHODS
The study comprised 20 patients, 9 infected and 11 non-infected, consecutively admitted to the ICU after moderate or major surgery. Twelve healthy volunteers were used as controls.


RESULTS
Leucocyte count, CRP and the plasma TNF, IL-1 and IL-6 concentrations were studied 24-48 h after the start of surgery. Axillary temperature, the duration of surgery, the number of packed red cells transfused, the APACHE II score and outcome were registered. Both infected and non-infected patients had higher plasma concentrations of IL-6 than the controls (p < 0.001 and p < 0.01 respectively). Patients with infection had a higher plasma IL-6 concentration than non-infected patients (p < 0.05). Similar analyses of plasma TNF concentrations revealed no differences between infected and non-infected patients. Plasma IL-1 was detected only occasionally. Non-survivors (n = 4) had higher plasma concentrations of TNF and IL-6 than survivors (p < 0.05 and p = 0.05 respectively). In non-infected patients a correlation between the number of units of packed red cells transfused and the plasma IL-6 concentration was observed (r = 0.73, p < 0.05).


CONCLUSIONS
No specific plasma cytokine pattern for infected patients subjected to surgery was observed. The effect of surgery and infection on the plasma IL-6 concentration seemed to be additive. Transfusion of packed red cells appeared to elevate the post-operative plasma IL-6 concentration.
Kristiansson
M
M
Department of Anaesthesiology and Intensive Care, Karolinska Institute, Huddinge University Hospital, Sweden.
Soop
M
M
Saraste
L
L
Sundqvist
K G
KG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006801:Humans; D007239:Infections / Q000097:blood* / Q000401:mortality; D007362:Intensive Care Units; D007375:Interleukin-1 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood* / Q000401:mortality; D011184:Postoperative Period; D011379:Prognosis; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*
D007375:Interleukin-1; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein