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Patients with postoperative infections have sticky neutrophils before operation
Akio Hidemura1, Hideaki Saito, Kazuhiko Fukatsu
1Department of Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
Abstract:
Appropriate polymorphonuclear neutrophil (PMN) recruitment is essential for host defense against infection. We investigated the significance of the preoperative PMN adhesion-migration process, as assessed by the flow chamber method, on postoperative infectious complications. Thirty-one consecutive patients with gastrointestinal malignancies, 21 colorectal and 10 gastric, who were undergoing elective surgery were enrolled. PMNs, isolated preoperatively from each patient's venous blood, were perfused onto a tumor necrosis factor alpha-stimulated human umbilical vein endothelial cell (HUVEC) monolayer through the flow chamber. We evaluated the adherent PMN number, the migrated PMN number, and the stuck PMN number by directly inspecting PMN interactions with a HUVEC monolayer under continuous shear flow simulating postcapillary venules. The expression of adhesion molecules on circulating PMNs was also measured. Patients were grouped into an infectious and a noninfectious group according to the occurrence of postoperative infectious complications defined by the Centers for Disease Control criteria. Eleven patients developed postoperative infectious complications. Although the number of preoperative in vitro adherent PMNs in patients with postoperative infection was significantly higher than in those without postoperative infection (P = 0.01), migrated PMN number was similar in both groups. Stuck PMN number tended to be higher in the infectious group than in the noninfectious group. The migrated PMN number showed a significant positive correlation with the adherent PMN number in the noninfectious group but not in the infectious group. Preoperative CD31 expression on circulating PMNs was significantly lower in the infectious group than in the noninfectious group. Preoperative in vitro derangement of the PMN adhesion-migration process is closely associated with postoperative infectious complications.
Insights
Preoperative polymorphonuclear neutrophil (PMN) adhesion was higher in patients who developed infections after surgery. Impaired PMN migration, a key part of host defense, predicts postoperative infectious complications.
Area of Science:
- Immunology
- Surgical Oncology
- Infectious Disease
Background:
- Polymorphonuclear neutrophil (PMN) recruitment is critical for combating infections.
- Surgical patients are at risk for postoperative infectious complications.
- Assessing PMN function preoperatively may predict infection risk.
Purpose of the Study:
- To investigate the relationship between preoperative PMN adhesion-migration function and postoperative infectious complications in gastrointestinal cancer surgery patients.
- To determine if in vitro PMN behavior predicts surgical site infections.
Main Methods:
- Thirty-one gastrointestinal malignancy patients undergoing elective surgery were studied.
- Preoperative PMN adhesion and migration were assessed using a flow chamber assay.
- PMN-endothelial cell interactions and adhesion molecule expression (CD31) were measured.
Main Results:
- Patients with postoperative infections had significantly higher preoperative in vitro adherent PMNs.
- Migrated PMN numbers were similar between infectious and non-infectious groups.
- Lower preoperative CD31 expression on PMNs was associated with increased infection risk.
Conclusions:
- Preoperative in vitro assessment of PMN adhesion-migration is linked to postoperative infectious complications.
- Impaired PMN adhesion-migration processes may indicate a higher risk of surgical site infections.
- CD31 expression levels could serve as a predictive biomarker for infection risk post-surgery.