Influence of preoperative nutritional state on inflammatory response aftersurgery

To investigate whether the preoperative nutritional state influences the po stoperative inflammatory reaction and immunity, we grouped patients whose p ostoperative nutritional support was performed by total parenteral nutritio n into the good nutritional state group (group I) and the latent protein-ca lorie malnutrition suggested group (group II) based on the preoperative rap id turnover protein (RTP). Nutritional markers markedly decreased after sur gery and recovered almost to preoperative levels on postoperative day (POD- ) 7 in groups I and II. Nutritional markers on POD-7 in group II were signi ficantly lower than those in group I (RTP, P < 0.001; albumin, P < 0.05). A fter surgery, levels of interleukin-6 (IL-6), C-reactive protein (CRP), and polymorphonuclear (PMN-) elastase were higher in group ill than in group I (P < 0.01). In groups I and II, IL-6 and interleukin-8 (IL-8) rose before the remarkable elevation of CRP and PMN-elastase. In group I, all the nutri tional markers showed a negative correlation with CRP and PMN-elastase. Fur ther, a positive correlation was observed between IL-6 and CRP and between IL-8 and PMN-elastase. In conclusion, evaluation of the preoperative nutrit ional state appears to be very important for the prediction of postoperativ e complication. (C) Elsevier Science Inc. 1999.