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Polymorphonuclear leukocyte activation. An early marker of the postsurgical sepsis response
C H Wakefield1, P D Carey, S Foulds
1Academic Surgical Unit, St Mary's Hospital Medical School, London, England.
Abstract:
It has been suggested that major surgery induces polymorphonuclear leukocyte (PMNL) dysfunction, which exposes patients to the development of sepsis. Conversely, the sepsis response and multisystem organ failure in patients after surgery is thought to be mediated by activated PMNLs. In a preliminary attempt to investigate this paradox, we studied functional (hydrogen peroxide production) and phenotypic (the adhesion/complement receptor CD11b) markers of PMNL activation in 28 patients undergoing elective major resectional surgery; 11 (39%) of these patients developed postoperative sepsis (the septic group). The mean (SEM) preoperative level of neutrophil CD11b expression (97.8 [6.2] mean channel fluorescence [MCF] and 101.42 [7.9] MCF; P = .74) and hydrogen peroxide production (109.51 [4.91] MCF and 104.53 [6.3] MCF; P = .5) were similar for the uncomplicated and septic groups, respectively. However, on the first postoperative day, both mean CD11b expression and hydrogen peroxide production were greater in those patients who subsequently developed postoperative sepsis (192.5 [38] MCF vs 128.6 [8.1] MCF for the septic group vs the uncomplicated group, respectively [P < .05], and 120.43 [2.56] MCF vs 109.61 [3.05] MCF for the septic group vs the uncomplicated group, respectively [P < .0001]). We suggest that an exaggerated PMNL activation response to surgery is an early event in those patients destined to develop postsurgical sepsis.
Insights
Major surgery can paradoxically impair or activate polymorphonuclear leukocytes (PMNLs). This study found exaggerated PMNL activation markers post-surgery in patients who later developed sepsis.
Area of Science:
- Immunology
- Surgical Pathology
- Critical Care Medicine
Background:
- Major surgery is linked to polymorphonuclear leukocyte (PMNL) dysfunction, potentially increasing sepsis risk.
- Conversely, activated PMNLs are implicated in sepsis and organ failure post-surgery, presenting a paradox.
Purpose of the Study:
- To investigate the role of PMNL activation in patients undergoing major surgery.
- To explore the paradox of PMNL dysfunction versus activation in postsurgical sepsis development.
Main Methods:
- Studied 28 patients undergoing elective major resectional surgery.
- Measured PMNL functional (hydrogen peroxide production) and phenotypic (CD11b expression) markers pre- and post-operatively.
- Compared markers between patients who developed sepsis and those who did not.
Main Results:
- Preoperative PMNL activation markers were similar in both groups.
- Postoperative day one showed significantly higher CD11b expression and hydrogen peroxide production in patients who developed sepsis.
- These findings suggest an exaggerated PMNL response in those progressing to sepsis.
Conclusions:
- An exaggerated PMNL activation response following surgery may be an early indicator of subsequent sepsis.
- This heightened activation could be a key factor in the development of postsurgical sepsis.