Enhanced polymorphonuclear leucocyte adhesion after surgical injury.
OBJECTIVE
To evaluate the relationship between the expression of the neutrophil adhesion receptor CD11b, functional neutrophil adhesion, and clinical outcomes in patients undergoing major surgical resections.


METHODS
Laboratory study.


METHODS
University hospital, United Kingdom.


METHODS
25 patients undergoing surgical resections for malignant disease.


METHODS
Blood obtained preoperatively and on postoperative days 1, 3, and 6. Neutrophils were assayed for CD11b expression in whole blood and following isolation using flow cytometry, and adhesion was measured using a chromogenic, gelatin-dependent adhesion assay, with and without stimulation by FMLP. Postoperative outcomes were classified as uncomplicated (n = 20) or sepsis according to ACCP/SCCM definitions (n = 5).


RESULTS
Whole blood neutrophil CD11b expression was significantly increased on the first postoperative day and in all patients was significantly higher in the sepsis group (p < 0.001, ANOVA). There was a significant increase in CD11b expression above preoperative concentrations after separation and stimulation with FMLP only in the sepsis group, 3 and 6 days postoperatively (p < 0.01, paired t-test). Functional neutrophil adhesion was significantly higher in the sepsis compared with the uncomplicated group at all time points postoperatively (p < 0.001, two way ANOVA).


CONCLUSIONS
Major operations are accompanied by upregulation of baseline CD11b expression mirrored by changes in neutrophil adhesion. Those patients who develop sepsis have greater degrees of CD11b expression and adhesion. These data present a potential pathophysiological role for neutrophils throughout the postoperative period in the development of sepsis and its sequelae after major operations.
Klava
A
A
Department of Surgery, St. James's University Hospital, Leeds, United Kingdom.
Windsor
A C
AC
Ramsden
C W
CW
Guillou
P J
PJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D018845:CD11 Antigens / Q000032:analysis*; D015815:Cell Adhesion Molecules / Q000032:analysis*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005434:Flow Cytometry; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology*; D011183:Postoperative Complications / Q000097:blood*; D011184:Postoperative Period; D012016:Reference Values; D012680:Sensitivity and Specificity; D006113:United Kingdom
D018845:CD11 Antigens; D015815:Cell Adhesion Molecules