title: Cardiopulmonary exercise capacity and preoperative markers of inflammation.
abstract: Explanatory mechanisms for the association between poor exercise capacity and infections following surgery are underexplored. We hypothesized that aerobic fitness-assessed by cardiopulmonary exercise testing (CPET)-would be associated with circulating inflammatory markers, as quantified by the neutrophil-lymphocyte ratio (NLR) and monocyte subsets. The association between cardiopulmonary reserve and inflammation was tested by multivariable regression analysis with covariates including anaerobic threshold (AT) and malignancy. In a first cohort of 240 colorectal patients, AT was identified as the sole factor associated with higher NLR (P = 0.03) and absolute and relative lymphopenia (P = 0.01). Preoperative leukocyte subsets and monocyte CD14(+) expression (downregulated by endotoxin and indicative of chronic inflammation) were also assessed in two further cohorts of age-matched elective gastrointestinal and orthopaedic surgical patients. Monocyte CD14(+) expression was lower in gastrointestinal patients (n = 43) compared to age-matched orthopaedic patients (n = 31). The circulating CD14(+)CD16(-) monocyte subset was reduced in patients with low cardiopulmonary reserve. Poor exercise capacity in patients without a diagnosis of heart failure is independently associated with markers of inflammation. These observations suggest that preoperative inflammation associated with impaired cardiorespiratory performance may contribute to the pathophysiology of postoperative outcome.
authors: Clinical Physiology, Division of Medicine, University College London, London WC1E 6BT, UK.
authors: Pervez
authors: P
authors: Sultan
authors: Clinical Physiology, Division of Medicine, University College London, London WC1E 6BT, UK.
authors: Mark R
authors: MR
authors: Edwards
authors: Clinical Physiology, Division of Medicine, University College London, London WC1E 6BT, UK.
authors: Ana
authors: A
authors: Gutierrez del Arroyo
authors: Clinical Physiology, Division of Medicine, University College London, London WC1E 6BT, UK.
authors: David
authors: D
authors: Cain
authors: Department of Anaesthesia, Derriford Hospital and Peninsula Medical School, Plymouth PL6 8DH, UK.
authors: J Robert
authors: JR
authors: Sneyd
authors: Department of Anaesthesia, Derriford Hospital and Peninsula Medical School, Plymouth PL6 8DH, UK.
authors: Richard
authors: R
authors: Struthers
authors: Department of Anaesthesia, Derriford Hospital and Peninsula Medical School, Plymouth PL6 8DH, UK.
authors: Gary
authors: G
authors: Minto
authors: Clinical Physiology, Division of Medicine, University College London, London WC1E 6BT, UK.
authors: Gareth L
authors: GL
authors: Ackland
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000503:physiopathology*; D018950:Lipopolysaccharide Receptors / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000378:metabolism; D009504:Neutrophils / Q000378:metabolism; D017452:Receptors, IgG / Q000378:metabolism
chemical_list: D015415:Biomarkers; D018950:Lipopolysaccharide Receptors; D017452:Receptors, IgG