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Altered Cell-mediated Immunity and Increased Postoperative Infection Rate in Long-term Alcoholic Patients

Spies, Claudia D.; Von Dossow, Vera; Eggers, Verena; Jetschmann, Gesine; El-Hilali, Ratiba; Egert, Julia; Fischer, Marc; Schröder, Torsten; Höflich, Conny and Sinha, Pranav, et al. (2004) In Anesthesiology 100(5). p.1088-1100
Abstract

Background: Preoperative alteration of T cell-mediated immunity as well as an altered immune response to surgical stress were found in long-term alcoholic patients. The aim of this study was to evaluate perioperative T cell-mediated immune parameters as well as cytokine release from whole blood cells after lipopolysaccharide stimulation and its association with postoperative infections. Methods: Fifty-four patients undergoing elective surgery of the aerodigestive tract were included in this prospective observational study. Long-term alcoholic patients (n = 31) were defined as having a daily ethanol consumption of at least 60 g and fulfilling the Diagnostic and Statistical Manual of Mental Disorders for either alcohol abuse or alcohol... (More)

Background: Preoperative alteration of T cell-mediated immunity as well as an altered immune response to surgical stress were found in long-term alcoholic patients. The aim of this study was to evaluate perioperative T cell-mediated immune parameters as well as cytokine release from whole blood cells after lipopolysaccharide stimulation and its association with postoperative infections. Methods: Fifty-four patients undergoing elective surgery of the aerodigestive tract were included in this prospective observational study. Long-term alcoholic patients (n = 31) were defined as having a daily ethanol consumption of at least 60 g and fulfilling the Diagnostic and Statistical Manual of Mental Disorders for either alcohol abuse or alcohol dependence. The nonalcoholic patients (n = 23) were defined as drinking less than 60 g ethanol/day. Blood samples to analyze the immune status were obtained on morning before surgery and on the morning of days 1, 3, and 5 after surgery. Results: Basic patient characteristics did not differ between groups. Before surgery, the T helper 1:T helper 2 ratio (Th1: Th2) was significantly lower (P < 0.01), whereas plasma interleukin 1β and lipopolysaccharide-stimulated interleukin 1ra from whole blood cells were increased in long-term alcoholic patients. After surgery, a significant suppression of the cytotoxic lymphocyte ratio (Tc1:Tc2), the interferon γ:interleukin 10 ratio from lipopolysaccharide-stimulated whole blood cells, and a significant increase of plasma interleukin 10 was observed. Long-term alcoholics had more frequent postoperative infections compared with nonalcoholic patients (54% vs. 26%; P = 0.03). Conclusions: T helper cell-mediated immunity was significantly suppressed before surgery and possibly led to inadequate cytotoxic lymphocyte and whole blood cell response in long-term alcoholic patients after surgery. This altered cell-mediated immunity might have accounted for the increased infection rate in long-term alcoholic patients after surgery.

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published
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Anesthesiology
volume
100
issue
5
pages
13 pages
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:11144357647
ISSN
0003-3022
DOI
10.1097/00000542-200405000-00010
language
English
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no
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93bb1651-fa8d-465a-9711-a45b21c53b3f
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2019-08-16 14:22:01
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2019-10-15 07:12:04
@article{93bb1651-fa8d-465a-9711-a45b21c53b3f,
  abstract     = {<p>Background: Preoperative alteration of T cell-mediated immunity as well as an altered immune response to surgical stress were found in long-term alcoholic patients. The aim of this study was to evaluate perioperative T cell-mediated immune parameters as well as cytokine release from whole blood cells after lipopolysaccharide stimulation and its association with postoperative infections. Methods: Fifty-four patients undergoing elective surgery of the aerodigestive tract were included in this prospective observational study. Long-term alcoholic patients (n = 31) were defined as having a daily ethanol consumption of at least 60 g and fulfilling the Diagnostic and Statistical Manual of Mental Disorders for either alcohol abuse or alcohol dependence. The nonalcoholic patients (n = 23) were defined as drinking less than 60 g ethanol/day. Blood samples to analyze the immune status were obtained on morning before surgery and on the morning of days 1, 3, and 5 after surgery. Results: Basic patient characteristics did not differ between groups. Before surgery, the T helper 1:T helper 2 ratio (Th1: Th2) was significantly lower (P &lt; 0.01), whereas plasma interleukin 1β and lipopolysaccharide-stimulated interleukin 1ra from whole blood cells were increased in long-term alcoholic patients. After surgery, a significant suppression of the cytotoxic lymphocyte ratio (Tc1:Tc2), the interferon γ:interleukin 10 ratio from lipopolysaccharide-stimulated whole blood cells, and a significant increase of plasma interleukin 10 was observed. Long-term alcoholics had more frequent postoperative infections compared with nonalcoholic patients (54% vs. 26%; P = 0.03). Conclusions: T helper cell-mediated immunity was significantly suppressed before surgery and possibly led to inadequate cytotoxic lymphocyte and whole blood cell response in long-term alcoholic patients after surgery. This altered cell-mediated immunity might have accounted for the increased infection rate in long-term alcoholic patients after surgery.</p>},
  author       = {Spies, Claudia D. and Von Dossow, Vera and Eggers, Verena and Jetschmann, Gesine and El-Hilali, Ratiba and Egert, Julia and Fischer, Marc and Schröder, Torsten and Höflich, Conny and Sinha, Pranav and Paschen, Christian and Mirsalim, Parwis and Brunsch, Ralf and Hopf, Jürgen and Marks, Christian and Wemecke, Klaus D. and Pragst, Fritz and Ehrenreich, Hannelore and Müller, Christian and Tonnesen, Hanne and Oelkers, Wolfgang and Rohde, Wolfgang and Stein, Christoph and Kox, Wolfgang J.},
  issn         = {0003-3022},
  language     = {eng},
  month        = {05},
  number       = {5},
  pages        = {1088--1100},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Anesthesiology},
  title        = {Altered Cell-mediated Immunity and Increased Postoperative Infection Rate in Long-term Alcoholic Patients},
  url          = {http://dx.doi.org/10.1097/00000542-200405000-00010},
  volume       = {100},
  year         = {2004},
}