title: Changes in serum and cerebrospinal fluid cytokines in response to non-neurological surgery: an observational study.
abstract: BACKGROUND
  Surgery launches an inflammatory reaction in the body, as seen through increased peripheral levels of cytokines and cortisol. However, less is known about perioperative inflammatory changes in the central nervous system (CNS).Our aim was to compare inflammatory markers in serum and cerebrospinal fluid (CSF) before and after surgery and evaluate their association with measures of blood-brain barrier (BBB) integrity.
  
  
  METHODS
  Thirty-five patients undergoing knee arthroplastic surgery with spinal anesthesia had CSF and serum samples drawn before, after and on the morning following surgery. Cytokines and albumin in serum and CSF and cortisol in CSF were assessed at all three points.
  
  
  RESULTS
  Cytokines and cortisol were significantly increased in serum and CSF after surgery (Ps <0.01) and CSF increases were greater than in serum. Ten individuals had an increased cytokine response and significantly higher CSF/serum albumin ratios (Ps <0.01), five of whom had albumin ratios in the pathological range (>11.8). Serum and CSF levels of cytokines were unrelated, but there were strong correlations between CSF IL-2, IL-10 and IL-13, and albumin ratios (Ps <0.05) following surgery.
  
  
  CONCLUSIONS
  Cytokine increases in the CNS were substantially greater than in serum, indicating that the CNS inflammatory system is activated during peripheral surgery and may be regulated separately from that in the peripheral body. CSF cytokine increase may indicate sensitivity to trauma and is linked to BBB macromolecular permeability.
authors.affiliation: Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden. sara.bromander@rmv.se
authors.forename: Sara
authors.initials: S
authors.lastname: Bromander
authors.forename: Rolf
authors.initials: R
authors.lastname: Anckarsäter
authors.forename: Marianne
authors.initials: M
authors.lastname: Kristiansson
authors.forename: Kaj
authors.initials: K
authors.lastname: Blennow
authors.forename: Henrik
authors.initials: H
authors.lastname: Zetterberg
authors.forename: Henrik
authors.initials: H
authors.lastname: Anckarsäter
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Wass
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty / Q000009:adverse effects*; D016207:Cytokines / Q000097:blood* / Q000134:cerebrospinal fluid*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000134:cerebrospinal fluid; D007249:Inflammation / Q000097:blood* / Q000134:cerebrospinal fluid* / Q000209:etiology; D007717:Knee / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019370:Observation
chemical_list: D016207:Cytokines; D006854:Hydrocortisone