REDUCED TNF-ALPHA AND IL-6 PRODUCTION IN PATIENTS WHO MOUNT A PREOPERATIVE ACUTE-PHASE RESPONSE

Background/aims: In some patients postoperative infective complication s are related to a reduced resistance to the operative trauma and the perioperative microbiological challenge. To investigate preoperative a lterations in the immune responses in patients who had mounted an acut e-phase response before the operation, we measured the capacity of tum or necrosis factor alpha and interleukin-6 production in whole blood. Patients/methods: Serum concentrations of C-reactive protein, alpha(1) -antitrypsin, albumin, and prealbumin were measured in 89 patients sub mitted for major abdominal surgery on their admission to hospital. Res ults: In 23 patients (26%) we found concentrations of at least one, an d in 16 patients (18%) of two or more of these variables beyond the re ference range, Patients who mounted an acute-phase response released 3 7% less TNF alpha (1339 vs. 848 pg/ml) and 31% less IL-6 (24 293 vs 16 900 pg/ml) when whole blood was stimulated with lipopolysaccharide 0. 5 mu g/ml. Conclusion: Patients who mount an acute-phase response befo re operation may thus have a downregulated immune response at the leve l of proinflammatory cytokines. This is likely to alter their resistan ce to invasive micro-organisms in the perioperative period.