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Does age affect liver function and the hepatic acute phase response after major abdominal surgery?
S W Suttner1, C Sürder, K Lang
1Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Akademisches Lehrkrankenhaus der Universität Mainz, Bremserstr. 79, 67063 Ludwigshafen, Germany. suttner@gmx.de
Intensive Care Medicine
|January 26, 2002
Summary
Elderly patients undergoing major abdominal surgery show a reduced hepatic acute phase response. This impaired liver function, indicated by lower acute phase protein (APP) synthesis, may impact recovery and prognosis in older individuals.
Area of Science:
- Hepatology
- Surgical Inflammation
- Geriatric Medicine
Background:
- The liver is central to the inflammatory response following major surgery or infection.
- Age significantly influences liver function and the synthesis of hepatic acute phase proteins (APPs).
Purpose of the Study:
- To investigate the impact of age on liver function and APP synthesis in elderly patients undergoing major abdominal surgery.
- To serially assess hepatic responses over a 3-day postoperative period.
Main Methods:
- A prospective, descriptive study involving 42 patients, categorized as 'adult' (<60 years) or 'elderly' (≥65 years).
- Serial measurements of inflammatory markers (IL-6, SAA, CRP, alpha1-AT, haptoglobin) and liver function tests (MEGX, alpha-GST) were performed.
- Standardized anesthesia and ICU protocols were applied, with blinded data analysis.
Main Results:
- Elderly patients exhibited a significantly higher IL-6 increase postoperatively compared to younger adults.
- Reduced peak concentrations of SAA, CRP, and alpha1-AT were observed in the elderly group.
- Impaired liver function was indicated by lower MEGX levels and higher alpha-GST concentrations in older patients post-surgery.
Conclusions:
- Elderly patients demonstrate a diminished hepatic acute phase response after major abdominal surgery.
- This reduced APP synthesis is linked to impaired hepatocyte function and integrity in older individuals.
- Further research is needed to clarify the clinical implications for postoperative complications and survival in the aged population.