Factors predicting postoperative infectious complications and early induction of inflammatory mediators in ulcerative colitis patients.
BACKGROUND
Positive outcomes after restorative proctocolectomy are compromised by a number of specific septic complications. However, there is no useful perioperative marker predicting postoperative infectious complications (PICs) in steroid overdosed patients with ulcerative colitis (UC).


METHODS
To determine factors associated with PICs and their relation to circulating levels of pro- and anti-inflammatory cytokines and neutrophil elastase (NE), we obtained perioperative blood samples from 60 UC patients.


RESULTS
Postoperative infectious complications were identified in 47% of cases. Patients who developed PICs had significantly longer disease duration, had been administered a greater total preoperative dosage of prednisolone, and had a higher body mass index. Logistic regression analysis showed that the total preoperative dosage of prednisolone was independently associated with the development of PICs. These patients showed suppressed systemic inflammation and pro- and anti-inflammatory cytokine induction. An early increase in the NE level was found to be predictive of PICs in the high-dose group, whereas there was no significant difference in neutrophil counts between the high- and low-dose groups.


CONCLUSIONS
Circulating NE levels in the early postoperative period might be a useful predictor of PICs in immune-controlled UC patients who received high doses of steroids.
Miki
Chikao
C
Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Edobashi 2-174, 514-8507, Tsu, Mie, Japan.
Ohmori
Yukinari
Y
Yoshiyama
Shigeyuki
S
Toiyama
Yuji
Y
Araki
Toshimitsu
T
Uchida
Keiichi
K
Kusunoki
Masato
M
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000097:blood / Q000601:surgery*; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D016737:Proctocolectomy, Restorative; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D018836:Inflammation Mediators