Surgical trauma and postoperative immune dysfunction.
BACKGROUND
In postoperative sepsis, mortality is increased due to the surgically induced immune dysfunction. Further causes of this traumatic effect on the immune system include burn injuries and polytrauma, as well as endogenous traumata like stroke. Several animal models have been defined to analyse the characteristics of trauma-induced immune suppression. This article will correlate our results from animal studies and clinical observations with the recent literature on postoperative immune suppression.


METHODS
The previously described model of surgically induced immune dysfunction (SID) was performed in mice by laparotomy and manipulation of the small intestine in the antegrade direction. Blood samples were collected 6 and 72 h following SID to analyse the white blood cell count and corticosterone levels. To assess the postoperative immune status in humans, we analysed expression of HLA-DR on monocytes of 118 patients by flow cytometry prior to and 24, 48 and 72 h after surgery.


RESULTS
The postoperative immune suppression in our SID model is characterised by lymphocytopenia and significantly increased corticosterone levels in mice dependent on the degree of surgical trauma. This is comparable to the postoperative situation in humans: major and especially long-lasting surgery results in a significantly reduced expression of HLA-DR on circulating monocytes. Previous studies describe a similar situation following burn injury and endogenous trauma, i.e. stroke.


CONCLUSIONS
We suggest the completion of our previously published sepsis classification due to the immune status at the onset of sepsis: type A as the spontaneously acquired sepsis and type B as sepsis in trauma-induced pre-existing immune suppression.
Department of Surgery: General Surgery, Visceral, Thoracic and Vascular Surgery, University Hospital Greifswald, Greifswald, Germany. pia.menges@uni-greifswald.de
P
P
Menges
W
W
Kessler
C
C
Kloecker
M
M
Feuerherd
S
S
Gaubert
S
S
Diedrich
J
J
van der Linde
A
A
Hegenbart
A
A
Busemann
T
T
Traeger
K
K
Cziupka
C-D
CD
Heidecke
S
S
Maier
D000368:Aged; D000818:Animals; D005260:Female; D006684:HLA-DR Antigens / Q000097:blood; D006801:Humans; D007154:Immune System Diseases / Q000209:etiology*; D007108:Immune Tolerance; D008297:Male; D051379:Mice; D008810:Mice, Inbred C57BL; D008875:Middle Aged; D011183:Postoperative Complications / Q000276:immunology*; D018805:Sepsis / Q000276:immunology*
D006684:HLA-DR Antigens