Abstract
BackgroundSurgery 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.MethodsThirty-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.ResultsCytokines 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.ConclusionCytokine 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.
Highlights
Aseptic trauma, such as peripheral surgery, can lead to an inflammatory response in the central nervous system (CNS), which has been associated with the development of postoperative delirium, depression and cognitive decline [1,2,3]
Some cytokines, such as interleukin (IL)-1, IL-2, IL-6, and IL-8, and tumor necrosis factor (TNF), generally act in a proinflammatory fashion while others, such as IL-4, IL-10 and IL-13 have anti-inflammatory effects, and their intricate balance is crucial for maintaining health [8]
The albumin ratio was calculated as cerebrospinal fluid (CSF) albumin/serum albumin (g/L)
Summary
Aseptic trauma, such as peripheral surgery, can lead to an inflammatory response in the central nervous system (CNS), which has been associated with the development of postoperative delirium, depression and cognitive decline [1,2,3]. Reactions caused by experimental peripheral injection of lipopolysaccharide antigen (LPS), treatment with cytokines to combat illnesses like cancer and hepatitis, as well as surgery have all been shown to have a profound impact on the brain, affecting both mood and cognition [1,2,3]. Cytokines are a group of important inflammatory mediators [7,8] that act in cascades, inducing or inhibiting each other. Surgery launches an inflammatory reaction in the body, as seen through increased peripheral levels of cytokines and cortisol. 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
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