title: Suppression of interleukin-6 to interleukin-10 ratio in chronic alcoholics: association with postoperative infections.
abstract: OBJECTIVE
  To investigate the interleukin-6 (IL-6) to interleukin-10 (IL-10) ratio and levels of sE-selectin in patients undergoing elective surgery of the upper digestive tract and to define the differences in the perioperative immune response between chronic alcoholic and non-alcoholic patients.
  
  
  METHODS
  Prospective pilot study.
  
  
  METHODS
  Single center, interdisciplinary intensive care unit (ICU) at a university hospital.
  
  
  RESULTS
  The study compared chronic alcoholics ( n=25) and non-alcoholics ( n=20) before and after surgery for resection of upper digestive tract tumors. White blood cell counts, C-reactive protein and circulating levels of sE-selectin, the pro-inflammatory cytokine IL-6 and the inhibitory cytokine IL-10, were obtained at hospital admission, preoperatively, postoperatively at ICU admission and 2 and 4 days later. Rates of postoperative infectious complications including pneumonia and sepsis were determined. sE-selectin only differed between chronic alcoholics and non-alcoholics preoperatively. Compared to non-alcoholics, chronic alcoholic patients showed a fourfold increase in circulating levels of IL-10 ( p<0.01) and a suppression of the IL-6/IL-10 ratio ( p=0.001) immediately after surgery. Coincident with the immune alterations, chronic alcoholics had a prolonged ICU stay ( p<0.01) and a threefold increased rate of wound infections ( p<0.05) and pneumonia ( p<0.01). Lower IL-6/IL-10 ratios were associated with increased rates of infectious complications ( p<0.05).
  
  
  CONCLUSIONS
  Chronic alcoholics had decreased IL-6/IL-10 ratios at ICU admission and increased rates of infectious complications in the postoperative ICU course. This may indicate immediate postoperative immune suppression before the onset of infections and may help to identify chronic alcoholic patients at risk.
authors.affiliation: Department of Anesthesiology and Intensive Care, University Hospital Charité, Campus Charité Mitte, Humboldt University, Schumannstrasse 20/21, 10117 Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Sander
authors.forename: M
authors.initials: M
authors.lastname: Irwin
authors.forename: P
authors.initials: P
authors.lastname: Sinha
authors.forename: E
authors.initials: E
authors.lastname: Naumann
authors.forename: W J
authors.initials: WJ
authors.lastname: Kox
authors.forename: C D
authors.initials: CD
authors.lastname: Spies
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications* / Q000276:immunology / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016753:Interleukin-10 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D012372:ROC Curve; D013530:Surgical Wound Infection / Q000209:etiology
chemical_list: D015850:Interleukin-6; D016753:Interleukin-10; D002097:C-Reactive Protein