Coagulation and cytokine profile after major hepatobiliary surgery in Chinese patients.
OBJECTIVE
Hypercoagulability and increased circulating cytokine levels have been separately reported after surgical operations. We investigated whether the cytokine level and postoperative coagulation profile would change similarly in Chinese patients undergoing major hepatobiliary surgery.


METHODS
Serial serum levels of IL-6, IL-1 beta and TNF-alpha were measured by colorimetric ELISA. Serial coagulation profile was measured by thrombelastography. Hemoglobin and white cell counts were also measured serially.


RESULTS
Only mild hypercoagulability was found at the 12th and 144th hours, evidenced by shortening of r-time and k-time on thrombelastography (P < 0.05). IL-6 and IL-1 beta levels were significantly raised from the 12th hour (P < 0.01) while TNF-alpha level was unchanged. From the 3rd hour to the 48th hour, there was negative correlation between IL-6 levels and various thrombelastographic parameters such as coagulation index (r = -0.777, P < 0.001); k-time (r = 0.478, P < 0.05); maximum amplitude (r = -0.688, P < 0.01) and angle (r = -0.665, P < 0.01).


CONCLUSIONS
We observed a much milder degree of hypercoagulability in Chinese patients after major hepatobiliary surgery as compared to those reported in other operations in non-Chinese patients. Unlike in sepsis where a close link between increased cytokine levels and hypercoagulability has been reported, increase in IL-6 was associated with less hypercoagulability in Chinese patients after major hepatobiliary surgery.
Ng
K F
KF
Department of Anesthesiology, University of Hong Kong, China. jkfng@hkucc.hku.hk
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M S
MS
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Gong
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Xiong
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D000328:Adult; D001772:Blood Cell Count; D016207:Cytokines / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006723:Hong Kong; D006801:Humans; D007375:Interleukin-1 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D013916:Thrombelastography; D019851:Thrombophilia / Q000175:diagnosis / Q000208:ethnology* / Q000209:etiology*; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D016207:Cytokines; D006454:Hemoglobins; D007375:Interleukin-1; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha