Influence of surgical intervention in the immune response of severely injured patients.
OBJECTIVE
Primary events such as severe injury and elective surgery cause a deterioration of the immune response measurable by reduction of expression of HLA-DR on monocytes or ex vivo LPS-induced TNFalpha production. The further influence of secondary surgery after severe injury on the immune response remains unresolved.


METHODS
Prospective observation study.


METHODS
Surgical intensive care unit of an university hospital.


METHODS
Sixteen severely injured patients with an ISS >25 points.


RESULTS
On day 1 after trauma and immediately before secondary surgery, mean fluorescence intensity (MFI) of HLA-DR expression on monocytes and TNFalpha ex vivo synthesis was significantly reduced compared to healthy donors. Overall, surgical intervention during the second week after trauma caused no further reduction of HLA-DR expression on monocytes and of the ex vivo TNFalpha-synthesis. However, major surgery such as intramedullary nailing or pelvic osteosynthesis caused reduction of the HLA-DR expression and TNFalpha-synthesis, whereas, minor surgical interventions such as osteosynthesis on peripheral joints exhibited no significant effects on the immune response. Surgical intervention performed to clear septic foci normalised immune response by elevating HLA-DR expression on monocytes and ex vivo TNFalpha synthesis. Severe injury caused elevated serum IL-10 levels, whereas secondary surgery did not induce a further increase in serum IL-10 levels.


CONCLUSIONS
This study shows that initial trauma as well as major secondary surgery causes a suppression of immune functions, whereas minor secondary surgery does not cause significant immune disturbance.
Flohé
Sascha
S
Department of Trauma Surgery, University Hospital of Essen, Hufelandstrasse 55, 45122 Essen, Germany. sascha.flohe@uni-essen.de
Lendemans
Sven
S
Schade
Fritz-Ulrich
FU
Kreuzfelder
Ernst
E
Waydhas
Christian
C
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005434:Flow Cytometry; D005858:Germany; D006684:HLA-DR Antigens / Q000032:analysis*; D006785:Hospitals, University; D006801:Humans; D007108:Immune Tolerance / Q000276:immunology*; D015601:Injury Severity Score; D016753:Interleukin-10 / Q000097:blood; D008070:Lipopolysaccharides / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000737:chemistry*; D009102:Multiple Organ Failure / Q000209:etiology; D011446:Prospective Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000145:classification; D016019:Survival Analysis; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis / Q000276:immunology*; D014947:Wounds and Injuries / Q000145:classification / Q000150:complications / Q000276:immunology* / Q000601:surgery*
D006684:HLA-DR Antigens; D008070:Lipopolysaccharides; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10