title: Postoperative immunosuppression markers and the occurrence of sepsis in patients with benign and malignant disease.
abstract: OBJECTIVE
  To investigate associations between the postoperative immune response and the levels of extracellular circulating DNA (cDNA), C-reactive protein (CRP), neutrophil/lymphocyte (N/L) ratio, and regulatory T (Treg) cells in the peripheral blood and their role as potential predictors of postoperative septic complications.
  
  
  METHODS
  This was a prospective observational study involving 115 adult patients who underwent elective surgery. Patients were divided into three groups: with benign disease, with malignant disease, and with malignant disease and administration of dexamethasone. Serum CRP levels, N/L ratio, monocyte human leukocyte antigen-DR (HLA-DR) expression, proportion of Treg cells, and cDNA levels were measured at different time points before and after surgery.
  
  
  RESULTS
  All patients had increased CRP levels after surgery. Septic patients had higher serum CRP levels at baseline. Compared with the other groups, the dexamethasone group had significantly higher CRP levels before and after surgery, a significantly higher N/L ratio before surgery, a significantly lower rise in the N/L ratio after surgery, and a significantly lower HLA-DR expression at baseline, which remained stable after surgery. In the malignant-disease group, we observed a significant postoperative decrease in the HLA-DR expression.
  
  
  CONCLUSIONS
  Our results suggest that the immunosuppressive effect of surgery and the presence of a malignant disease may contribute to a higher risk of postoperative sepsis. Preoperative CRP levels may be a reliable predictor of sepsis in oncological patients.
authors.affiliation: Department of Pathophysiology, Faculty of Medicine Osijek, J.J. Strossmayer University of Osijek, Huttlerova 4, 31000, Osijek, Croatia.
authors.forename: Tamara
authors.initials: T
authors.lastname: Alkhamis
authors.forename: Dubravka
authors.initials: D
authors.lastname: Ivić
authors.forename: Jasenka
authors.initials: J
authors.lastname: Wagner
authors.forename: Josip
authors.initials: J
authors.lastname: Ivić
authors.forename: Blaženka
authors.initials: B
authors.lastname: Dobrošević
authors.forename: Ivana
authors.initials: I
authors.lastname: Turina
authors.forename: Kristina
authors.initials: K
authors.lastname: Kralik
authors.forename: Jerko
authors.initials: J
authors.lastname: Barbić
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000276:immunology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000276:immunology*; D008875:Middle Aged; D009369:Neoplasms / Q000276:immunology* / Q000601:surgery*; D011446:Prospective Studies; D018805:Sepsis / Q000188:drug therapy / Q000276:immunology*; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000276:immunology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D002097:C-Reactive Protein