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Surgical Trauma and Postoperative Immune Dysfunction

  • Background: In postoperative sepsis, mortality is increased due to the surgically induced immune dysfunction. Further causes of this traumatic effect on the immune system include burn injuries and polytrauma, as well as endogenous traumata like stroke. Several animal models have been defined to analyse the characteristics of trauma-induced immune suppression. This article will correlate our results from animal studies and clinical observations with the recent literature on postoperative immune suppression. Methods: The previously described model of surgically induced immune dysfunction (SID) was performed in mice by laparotomy and manipulation of the small intestine in the antegrade direction. Blood samples were collected 6 and 72 h following SID to analyse the white blood cell count and corticosterone levels. To assess the postoperative immune status in humans, we analysed expression of HLA-DR on monocytes of 118 patients by flow cytometry prior to and 24, 48 and 72 h after surgery. Results: The postoperative immune suppression in our SID model is characterised by lymphocytopenia and significantly increased corticosterone levels in mice dependent on the degree of surgical trauma. This is comparable to the postoperative situation in humans: major and especially long-lasting surgery results in a significantly reduced expression of HLA-DR on circulating monocytes. Previous studies describe a similar situation following burn injury and endogenous trauma, i.e. stroke. Conclusions: We suggest the completion of our previously published sepsis classification due to the immune status at the onset of sepsis: type A as the spontaneously acquired sepsis and type B as sepsis in trauma-induced pre-existing immune suppression.

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Author: P. Menges, W. Kessler, C. Kloecker, M. Feuerherd, S. Gaubert, S. Diedrich, J. van der Linde, A. Hegenbart, A. Busemann, T. Traeger, K. Cziupka, C.-D. Heidecke, S. Maier
URN:urn:nbn:de:gbv:9-opus-31300
URL:http://www.karger.com/esr
DOI:https://doi.org/10.1159/000338196
ISSN:0014-312X
ISSN:1421-9921
Pubmed Id:https://pubmed.ncbi.nlm.nih.gov/22653168
Parent Title (English):European Surgical Research
Publisher:S. Karger AG
Place of publication:Basel, Switzerland
Document Type:Article
Language:English
Date of first Publication:2012/05/25
Release Date:2020/09/29
Tag:Immune system; Postoperative immune suppression; Sepsis; Trauma
GND Keyword:-
Volume:48
Issue:4
First Page:180
Last Page:186
Faculties:Universitätsmedizin / Klinik und Poliklinik für Chirurgie
Licence (German):License LogoUrheberrechtlich geschützt