Reduced TNFalpha and IL-6 production in patients who mount a preoperative acute phase response.
OBJECTIVE
In some patients postoperative infective complications are related to a reduced resistance to the operative trauma and the perioperative microbiological challenge. To investigate preoperative alterations in the immune responses in patients who had mounted an acute-phase response before the operation, we measured the capacity of tumor necrosis factor alpha and interleukin-6 production in whole blood.


METHODS
Serum concentrations of C-reactive protein, alpha1-antitrypsin, albumin, and prealbumin were measured in 89 patients submitted for major abdominal surgery on their admission to hospital.


RESULTS
In 23 patients (26%) we found concentrations of at least one, and in 16 patients (18%) of two or more of these variables beyond the reference range. Patients who mounted an acute-phase response released 37% less TNFalpha (1339 vs. 848 pg/ml) and 31% less IL-6 (24293 vs. 16900 pg/ml) when whole blood was stimulated with lipopolysaccharide 0.5 microg/ml.


CONCLUSIONS
Patients who mount an acute-phase response before operation may thus have a downregulated immune response at the level of proinflammatory cytokines. This is likely to alter their resistance to invasive micro-organisms in the perioperative period.
Haupt
W
W
Department of Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
Zirngibl
H
H
Klein
P
P
Riese
J
J
Hohenberger
W
W
D000210:Acute-Phase Reaction / Q000175:diagnosis / Q000276:immunology*; D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism*; D003955:Diagnostic Tests, Routine; D004066:Digestive System Diseases / Q000276:immunology / Q000601:surgery*; D004067:Digestive System Neoplasms / Q000276:immunology / Q000601:surgery*; D005260:Female; D006801:Humans; D007108:Immune Tolerance / Q000276:immunology; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011228:Prealbumin / Q000378:metabolism; D012016:Reference Values; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000276:immunology*; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*; D000515:alpha 1-Antitrypsin / Q000378:metabolism
D015850:Interleukin-6; D011228:Prealbumin; D012709:Serum Albumin; D014409:Tumor Necrosis Factor-alpha; D000515:alpha 1-Antitrypsin; D002097:C-Reactive Protein