Surgical trauma and postoperative immune dysfunction
P Menges1, W Kessler, C Kloecker
1Department of Surgery: General Surgery, Visceral, Thoracic and Vascular Surgery, University Hospital Greifswald, Greifswald, Germany. pia.menges@uni-greifswald.de
Summary
Postoperative sepsis increases mortality due to immune dysfunction. This study links animal models and human data, showing trauma-induced immune suppression impacts sepsis classification.
Area of Science:
- Immunology
- Surgical Pathology
- Critical Care Medicine
Background:
- Postoperative sepsis mortality is linked to surgically induced immune dysfunction.
- Trauma, burns, and stroke exacerbate immune suppression.
- Animal models and clinical observations are used to study trauma-induced immune suppression.
Purpose of the Study:
- To correlate animal study results with clinical observations of postoperative immune suppression.
- To analyze the characteristics of trauma-induced immune suppression.
- To propose an updated sepsis classification based on immune status.
Main Methods:
- A mouse model of surgically induced immune dysfunction (SID) involved laparotomy and small intestine manipulation.
- Blood samples analyzed white blood cell count and corticosterone levels in mice.
- Human subjects (118) had HLA-DR expression on monocytes analyzed via flow cytometry pre- and post-surgery.
Main Results:
- The SID mouse model showed lymphocytopenia and increased corticosterone levels.
- Surgically induced immune dysfunction in mice correlated with the degree of surgical trauma.
- Human patients exhibited reduced HLA-DR expression on monocytes after major or long-lasting surgery.
Conclusions:
- Postoperative immune suppression, characterized by reduced HLA-DR expression, is comparable across species and trauma types.
- A new sepsis classification is proposed: Type A (spontaneous) and Type B (trauma-induced immune suppression).
- Understanding immune status is crucial for classifying and potentially treating sepsis in trauma patients.
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