title: Altered cell-mediated immunity and increased postoperative infection rate in long-term alcoholic patients.
abstract: BACKGROUND
  Preoperative alteration of T cell-mediated immunity as well as an altered immune response to surgical stress were found in long-term alcoholic patients. The aim of this study was to evaluate perioperative T cell-mediated immune parameters as well as cytokine release from whole blood cells after lipopolysaccharide stimulation and its association with postoperative infections.
  
  
  METHODS
  Fifty-four patients undergoing elective surgery of the aerodigestive tract were included in this prospective observational study. Long-term alcoholic patients (n = 31) were defined as having a daily ethanol consumption of at least 60 g and fulfilling the Diagnostic and Statistical Manual of Mental Disorders for either alcohol abuse or alcohol dependence. The nonalcoholic patients (n = 23) were defined as drinking less than 60 g ethanol/day. Blood samples to analyze the immune status were obtained on morning before surgery and on the morning of days 1, 3, and 5 after surgery.
  
  
  RESULTS
  Basic patient characteristics did not differ between groups. Before surgery, the T helper 1:T helper 2 ratio (Th1: Th2) was significantly lower (P < 0.01), whereas plasma interleukin 1beta and lipopolysaccharide-stimulated interleukin 1ra from whole blood cells were increased in long-term alcoholic patients. After surgery, a significant suppression of the cytotoxic lymphocyte ratio (Tc1:Tc2), the interferon gamma:interleukin 10 ratio from lipopolysaccharide-stimulated whole blood cells, and a significant increase of plasma interleukin 10 was observed. Long-term alcoholics had more frequent postoperative infections compared with nonalcoholic patients (54%vs. 26%; P = 0.03).
  
  
  CONCLUSIONS
  T helper cell-mediated immunity was significantly suppressed before surgery and possibly led to inadequate cytotoxic lymphocyte and whole blood cell response in long-term alcoholic patients after surgery. This altered cell-mediated immunity might have accounted for the increased infection rate in long-term alcoholic patients after surgery.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Mitte, Schumannstrasse 20/21, 10098 Berlin, Germany. claudia.spies@charite.de
authors.forename: Claudia D
authors.initials: CD
authors.lastname: Spies
authors.forename: Vera
authors.initials: V
authors.lastname: von Dossow
authors.forename: Verena
authors.initials: V
authors.lastname: Eggers
authors.forename: Gesine
authors.initials: G
authors.lastname: Jetschmann
authors.forename: Ratiba
authors.initials: R
authors.lastname: El-Hilali
authors.forename: Julia
authors.initials: J
authors.lastname: Egert
authors.forename: Marc
authors.initials: M
authors.lastname: Fischer
authors.forename: Torsten
authors.initials: T
authors.lastname: Schröder
authors.forename: Conny
authors.initials: C
authors.lastname: Höflich
authors.forename: Pranav
authors.initials: P
authors.lastname: Sinha
authors.forename: Christian
authors.initials: C
authors.lastname: Paschen
authors.forename: Parwis
authors.initials: P
authors.lastname: Mirsalim
authors.forename: Ralf
authors.initials: R
authors.lastname: Brunsch
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hopf
authors.forename: Christian
authors.initials: C
authors.lastname: Marks
authors.forename: Klaus-D
authors.initials: KD
authors.lastname: Wernecke
authors.forename: Fritz
authors.initials: F
authors.lastname: Pragst
authors.forename: Hannelore
authors.initials: H
authors.lastname: Ehrenreich
authors.forename: Christian
authors.initials: C
authors.lastname: Müller
authors.forename: Hanne
authors.initials: H
authors.lastname: Tonnesen
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Oelkers
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Rohde
authors.forename: Christoph
authors.initials: C
authors.lastname: Stein
authors.forename: Wolfgang J
authors.initials: WJ
authors.lastname: Kox
mesh_terms: D000437:Alcoholism / Q000188:drug therapy / Q000276:immunology* / Q000601:surgery*; D019072:Antibiotic Prophylaxis; D002444:Cefuroxime / Q000494:pharmacology / Q000627:therapeutic use; D016207:Cytokines / Q000378:metabolism; D005260:Female; D006801:Humans; D007111:Immunity, Cellular / Q000187:drug effects; D008297:Male; D008795:Metronidazole / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy / Q000276:immunology*; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000276:immunology*; D018417:Th1 Cells / Q000187:drug effects / Q000276:immunology; D018418:Th2 Cells / Q000187:drug effects / Q000276:immunology
chemical_list: D016207:Cytokines; D008795:Metronidazole; D002444:Cefuroxime