Abstract
IntroductionPostoperative infection is a major cause of morbidity and mortality. We investigated two serum markers for their ability to identify patients at risk for postoperative infection. Mannan-binding lectin (MBL) is a central molecule of the innate immune system and MBL deficiency is known to predispose to infection. Procalcitonin (PCT) is a sensitive marker for bacterial infection.MethodsWe investigated 162 patients undergoing elective surgery for cancer of the gastrointestinal tract. Patients were classified as having no complications (group A), having infection for unknown reason (group B) or having sepsis after events like aspiration or anastomotic leakage (group C). Analysis was done pre- and postoperatively for serum levels of MBL, PCT and C-reactive-protein. DNA was preoperatively sampled and stored and later analysed for genetic polymorphisms of MBL.ResultsThe preoperative serum levels of MBL were significantly lower in group B patients than in group A patients (1332 ± 466 ng/ml versus 2523 ± 181 ng/ml). PCT measured on day one post-surgery was significantly higher in group B patients than in group A (3.33 ± 1.08 ng/ml versus 1.38 ± 0.17 ng/ml). Patients with an aberrant MBL genotype had a significantly higher risk of postoperative infections than wild-type carriers (p < 0.05).ConclusionPreoperative MBL and early postoperative PCT measurement may help identify patients at risk for postoperative infection.
Highlights
Postoperative infection is a major cause of morbidity and mortality
The preoperative serum levels of Mannan-binding lectin (MBL) were significantly lower in group B patients than in group A patients (1332 ± 466 ng/ml versus 2523 ± 181 ng/ml)
Complications were termed 'postoperative infection' when signs of sepsis or systemic inflammatory response syndrome occurred with no obvious bacterial contamination or specific surgical problem
Summary
Postoperative infection is a major cause of morbidity and mortality. Infection is a major reason for postoperative morbidity and mortality. Some infections can be attributed to distinct events leading to an overwhelming bacterial load that would cause sepsis even in healthy persons, such as anastomotic leakage and aspiration (group C in this study). An initial source of infection is not apparent, but it still occurs (group B in this study). Events of this type include bactaeremia of unknown reason, hospital acquired pneumonia, infection of indwelling catheters and bacterial translocation through the enteral mucosa. Various markers, including C-reactive protein (CRP), tumor necrosis factor α, IL-1, IL-6 and IL-8, have been studied for their ability to predict, diagnose and to differentiate infection, systemic inflammatory response syndrome and sepsis [2,3,4]
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