Neutrophil priming as a surgery-related risk factor for postoperative infectious complications in patients with ulcerative colitis.
OBJECTIVE
The present study was designed to assess whether preoperative neutrophil priming under surgical stress has causal effects on the postoperative clinical outcomes of ulcerative colitis (UC) patients.


METHODS
In 63 consecutive UC patients, perioperative changes in cytokines and neutrophil elastase (NE) were quantified and their relationships to postoperative infectious complications (PICs) were evaluated.


RESULTS
A preoperative increase in NE (high group: Group H) was associated with longer disease duration and greater preoperative total amount of steroids administered. Patients in Group H developed more PICs than those in the low NE group when they underwent surgery >240 min. In Group H, the NE level remained high after longer duration surgery, but decreased rapidly after shorter duration surgery. Multivariate analyses revealed that the total amount of steroids used and preoperative NE level were independent risk factors for predicting PICs in the longer operation group.


CONCLUSIONS
Preoperative neutrophil activation may become a risk factor for postoperative morbidity when the patients undergo intense surgical stress. The most important procedures for preventing postoperative morbidity in high-risk UC patients may be reducing surgical stress and/or controlling neutrophil activation perioperatively.
Miki
Chikao
C
Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
Yoshiyama
Shigeyuki
S
Okita
Yoshiki
Y
Araki
Toshimitsu
T
Uchida
Keiichi
K
Yanagi
Hidenori
H
Kusunoki
Masato
M
D000328:Adult; D015415:Biomarkers / Q000097:blood; D003093:Colitis, Ulcerative / Q000097:blood / Q000601:surgery*; D016207:Cytokines / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D015994:Incidence; D019272:Leukocyte Elastase / Q000097:blood*; D008297:Male; D018375:Neutrophil Activation / Q000502:physiology*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D015996:Survival Rate; D016896:Treatment Outcome
D015415:Biomarkers; D016207:Cytokines; D019272:Leukocyte Elastase