How does major abdominal surgery induce procalcitonin and IL-6 in the postoperative period?

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Introduction

Major abdominal surgery is often complicated by systemic inflammatory response (SIRS), local or general infection, sepsis and even septic shock. It is important to evaluate the risk of these serious complications to prevent them. It has been demonstrated that circulating markers of inflammation can be helpful in early diagnosis of surgical infection in the postoperative period. The aim of my study was to evaluate how major abdominal surgery induces interleukin 6 and procalcitonin by itself and to determine the usefulness of these markers in diagnosis of infectious complications.

Study design

Prospective clinical study approved by local Ethics Committee.

Patients

Thirty patients, ASA II-IV, undergoing elective surgery of the gastrointestinal system were studied. Surgical procedures included: gastrectomy or oesophagus resection (N=10), Whipple's operation (N=10), bowel resection (N=5), partial liver resection (N=2), others (N=3). In all patients, antibiotic prophylaxis (24-48h) was applied. Eleven patients developed local infection (wound N=6, lung infection N=3) or general infection (N=2). None of the analysed patients died; the total period of hospital treatment varied from 15 to 110 days.

Methods

Blood samples were taken during induction of anaesthesia and on days 1, 3, 5 and 7 after surgery. IL-6 measurements were performed by immunoradiometric assay (IL-6-IRMA, BIOSOURCE) and procalcitonin was measured by illuminometric method (PCT LUMItest, Brahms). Number of SIRS criteria and SOFA score were assessed at the same time points.

Results

We observed low plasma levels of both IL-6 and PCT prior to surgery and a slight increase in PCT at the first postoperative day in patients with signs of infection accompanied by increases in SIRS and SOFA assessment.

In two patients with general infection, the highest levels of PCT were 8.41 and 7.95 with IL-6 levels of 3500 and 3700 respectively.

Conclusions

Major abdominal surgery slightly increases procalcitonin serum levels in patients with infectious complications only, with the peak level 24-48 h after operation. Increase of IL-6 serum levels occurs 24-48 h after surgery in all patients and correlates with the assessment of inflammation measured by the number of SIRS criteria. PCT is a marker of infection rather than inflammation.

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