Abstract
In the present study we quantified a panel of systemic inflammation parameters in patients undergoing elective surgery with a view to evaluate pre-surgical inflammation status in relation to consequences post-surgery. The investigation revealed significantly decreased levels of plasma TNF-α, IL1-β, IL7, IL-8, MIP-1a and IL-1Ra in 79% of patients at 6 hrs post-surgery which have been designated by us a ‘hypo-responsive’ cases and the balance 21% of patients displayed significantly elevated levels of the above cytokines in plasma that have been designated a ‘hyper-responsive’ phenotype by us. Expression of HLA-DR, CD40, CD80, TLR-2, TLR-4 and CD36 on circulating monocytes as shown by multicolour flow-cytometry was significantly decreased post-surgery in hypo-responsive patients. Similarly, PBMCs of hypo-responsive cases responded very poorlyin vitrowhen stimulated with toll-like receptor (TLR) agonists. There was an inverse association between levels of plasma inflammatory cytokines pre-surgery and hypo-responsive consequences post-surgery. Similarly, patients displaying the hyper-responsive phenotype were found to express very low levels of inflammatory cytokines pre-surgery. Taken together the current study offers two novel findings: a) a bimodal inflammatory response post-elective surgery viz., one major cohort displaying hypo-responsive state and another minor group a hyper-responsive phenotype and b) pre-surgery inflammation status determining the direction of inflammation consequence post-surgery. These findings seem to offer laboratory tools for predicting onset of inflammation post-surgery – considering that SIRS and sepsis are consequences of surgery induced inflammation this study offers predictive indicators for clinical complications post-surgery.
Highlights
Sepsis and multiorgan failure (MOF) are the leading causes of death in surgical patients[1,2,3]
An association between lower pre-operative plasma IL-6 and early allograft dysfunction due to high systemic inflammation[18] and higher pre-operative systemic inflammation has been demonstrated with increased risk of infection post-surgery[19,20]
The current study was undertaken to investigate if pre-operative inflammation status would contribute and determine post-operative inflammatory responses in patients undergoing elective surgery
Summary
Sepsis and multiorgan failure (MOF) are the leading causes of death in surgical patients[1,2,3]. There are reports claiming downregulated expression of TLRs on circulatory monocytes as well as impaired responses to PAMPs in patients post-surgery[15,16]. An association between lower pre-operative plasma IL-6 and early allograft dysfunction due to high systemic inflammation[18] and higher pre-operative systemic inflammation has been demonstrated with increased risk of infection post-surgery[19,20]. These reports suffer from lack of robust and comprehensive measurement of cellular and molecular parameters of inflammation and the current study was designed to fill this lacuna
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
