Coagulation and cytokine profile after major hepatobiliary surgery in Chinese patients

Background/Aims: Hypercoagulability and increased circulating cytokine leve ls have been separately reported after surgical operations. We investigated whether the cytokine level and postoperative coagulation profile would cha nge similarly in Chinese patients undergoing major hepatobiliary surgery. Methodology: Serial serum levels of IL-6, IL-1 beta and TNF-alpha were meas ured by colorimetric ELISA. Serial coagulation profile was measured by thro mbelastography. Hemoglobin and white cell counts were also measured seriall y. Results: Only mild hypercoagulability was found at the 12th and 144th hours , evidenced by shortening of r-time and k-time on thrombelastography (P<0.0 5). IL-6 and IL-1 beta levels were significantly raised from the 12th hour (P<0.01) while TNF-alpha level was unchanged. From the 3rd hour to the 48th hour, there was negative correlation between IL-6 levels and various throm belastographic parameters such as coagulation index (r=-0.777, P<0.001) k-t ime (r=0.478, P<0.05); maximum amplitude (r=-0.688, P<0.01) and angle (r=-0 .665, P<0.01). Conclusions: We observed a much milder degree of hypercoagulability in Chin ese patients after major hepatobiliary surgery as compared to those reporte d in other operations in non-Chinese patients. Unlike in sepsis where a clo se link between increased cytokine levels and hypercoagulability has been r eported, increase in: IL-6 was associated with less hypercoagulability in C hinese patients after major hepatobiliary surgery.