Preoperative Paraoxonase 1 Activity, Polymorphism, and Its Correlation with Surgical Site Infection in Abdominal...

Surgical site infection (SSI) is the most common postoperative complication and leads to a poor prognosis. SSI triggers the acute-phase response, which leads to increased levels of high-sensitivity C-reactive protein (hsCRP) and myeloperoxidase (MPO). The HDL-associated enzyme Paraoxonase 1 (PON1) exhibits anti-inflammatory, lactonase, anti-atherogenic, and anti-apoptotic properties that help prevent inflammation and infection. The present study aimed to investigate preoperative PON1 activity and polymorphism, and their correlation with SSI in abdominal surgeries.

This prospective cohort study included 181 patients undergoing various abdominal surgeries at a rural tertiary healthcare center. Preoperative blood samples were centrifuged and used to estimate PON1 activity, PON1 polymorphism, MPO activity, and hsCRP levels. Patients were monitored postoperatively until discharge or the development of SSIs.

Out of 181 abdominal surgeries, a total of 78 (43%) developed SSIs. Significantly more patients developed SSIs in the first (n = 24; odds ratio (OR) = 2.78 [1.18-6.52]) and second quartiles (n = 22; OR = 2.5 [1.05-5.95]) of paraoxonase activity than in the fourth quartile (n = 13). Patients with SSIs showed significantly lower preoperative PON1 activity and higher preoperative hsCRP levels (58.66 ± 40.15 mg/L and 38.45 ± 26.17 mg/L, respectively) than patients without SSIs. The R phenotype is significantly associated with SSI compared to the Q phenotype.

Low preoperative PON1 activity and the presence of the R allele may be associated with SSI. Preoperative PON1 activity might serve as a potential marker for SSI risk. Measuring preoperative PON1 activity may help identify patients at risk for postoperative infections.