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van der Meij BS, Deutz NE, Rodriguez RE, Engelen MP. Increased amino acid turnover and myofibrillar protein breakdown in advanced cancer are associated with muscle weakness and impaired physical function. Clin Nutr 2019; 38:2399-2407. [DOI: 10.1016/j.clnu.2018.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/23/2018] [Accepted: 10/26/2018] [Indexed: 11/29/2022]
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Westfall JC, Cheng TW, Farber A, Jones DW, Eslami MH, Kalish JA, Rybin D, Siracuse JJ. Hypoalbuminemia Predicts Increased Readmission and Emergency Department Visits After Lower Extremity Bypass. Vasc Endovascular Surg 2019; 53:629-635. [PMID: 31416401 DOI: 10.1177/1538574419868869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Preoperative hypoalbuminemia is associated with poor outcomes across many surgical fields. However, the effects on outcomes after lower extremity bypass (LEB), particularly over the 90-day global surgical period, are unclear. Our goal was to analyze the effect of hypoalbuminemia within 90 days after LE bypass. METHODS We performed a single-center retrospective review of all infrainguinal LEBs from 2007 to 2017. Patients were categorized into 3 preoperative albumin groups: severe hypoalbuminemia (SH; albumin ≤2.8g/dL), mild-moderate hypoalbuminemia (MH; albumin >2.8-3.5g/dL), and normal albumin (albumin >3.5g/dL). Patient and procedural details were recorded. Outcomes analyzed included wound infection, myocardial infarction (MI), pulmonary complications, early graft occlusion (≤30 days), mortality, and emergency department (ED) presentation and readmissions within 30 and 90 days. Multivariable analysis was performed. RESULTS We identified 313 patients undergoing LEB-45 (14.4%) with SH, 133 (42.5%) with MH, and 135 (43.1%) with normal albumin. Overall, the mean age was 65.7 years, and 63.3% were male. The SH group more frequently had tissue loss, diabetes, hypertension, end-stage renal disease, preoperative hematocrit <30%, and patients admitted preoperatively (all P < .05). There were no significant differences in wound complications, MI, pulmonary complications, early graft occlusion, 30-day or 90-day mortality, and 30-day ED presentation. Severe hypoalbuminemia compared to MH and normal albumin, respectively, had significantly higher rates of 30-day readmission (40% vs 30.8% vs 17.8%, P = .005), 90-day ED presentation (55.6% vs 33.8% vs 29.6%, P = .006), and 90-day readmission (66.7% vs 48.9% vs 35.6%, P = .001). Multivariable analysis showed that SH was independently associated with 90-day ED presentation (odds ratio [OR]: 2.8, 95% confidence interval [CI]: 1.23-6.36, P = .014) and 90-day readmission (OR: 2.63, 95% CI: 1.21-5.71, P = .015). CONCLUSION Our study suggests that patients with SH undergoing LEB had similar perioperative complication rates compared to normal albumin and MH groups, and SH was independently associated with 90-day ED presentation and readmission. Further studies are needed to assess other factors associated with ED visits and readmission.
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Affiliation(s)
- John C Westfall
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Thomas W Cheng
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Douglas W Jones
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Mohammad H Eslami
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jeffrey A Kalish
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Denis Rybin
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
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Oki S, Toiyama Y, Okugawa Y, Shimura T, Okigami M, Yasuda H, Fujikawa H, Okita Y, Yoshiyama S, Hiro J, Kobayashi M, Ohi M, Araki T, Inoue Y, Mohri Y, Kusunoki M. Clinical burden of preoperative albumin-globulin ratio in esophageal cancer patients. Am J Surg 2017; 214:891-898. [DOI: 10.1016/j.amjsurg.2017.04.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/28/2017] [Accepted: 04/09/2017] [Indexed: 12/13/2022]
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Mujagic E, Marti WR, Coslovsky M, Zeindler J, Staubli S, Marti R, Mechera R, Soysal SD, Gürke L, Weber WP. The role of preoperative blood parameters to predict the risk of surgical site infection. Am J Surg 2017; 215:651-657. [PMID: 28982517 DOI: 10.1016/j.amjsurg.2017.08.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/17/2017] [Accepted: 08/21/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Routine preoperative blood work is not recommended but selected biochemical markers may predict the risk of surgical site infection (SSI). This study examines the association between preoperative biochemical markers and the risk of SSI. METHODS This observational cohort study, nested in a randomized controlled trial, was conducted at two tertiary referral centers in Switzerland. RESULTS 122 (5.8%) of 2093 patients experienced SSI. Preoperative increasing levels of albumin (OR 0.93), CRP (OR 1.34), hemoglobin (OR 0.87) and eGFR (OR 0.90) were significantly associated with the odds of SSI. The same accounts for categorized parameters. The highest area under the curve from ROC curves was 0.62 for albumin. Positive predictive values ranged from 6.4% to 9.5% and negative predictive values from 94.8% to 95.7%. The association of CRP, mildly and moderately decreased eGFR and hemoglobin with the odds of SSI remained significant on multivariate analysis. CONCLUSIONS Our results do not support generally delaying elective surgery based on preoperative blood results. However, it may be considered in situations with potentially severe sequelae of SSI.
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Affiliation(s)
- Edin Mujagic
- Department of Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Walter R Marti
- Department of Surgery, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland.
| | - Michael Coslovsky
- University of Basel, University Hospital, Department of Clinical Research, Clinical Trial Unit, Spitalstrasse 12, 4031, Basel, Switzerland.
| | - Jasmin Zeindler
- Department of Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Sebastian Staubli
- Department of Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Regula Marti
- Department of Surgery, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland.
| | - Robert Mechera
- Department of Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Savas D Soysal
- Department of Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Lorenz Gürke
- Department of Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Walter P Weber
- Department of Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
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Peacock MR, Farber A, Eslami MH, Kalish JA, Rybin D, Doros G, Shah NK, Siracuse JJ. Hypoalbuminemia Predicts Perioperative Morbidity and Mortality after Infrainguinal Lower Extremity Bypass for Critical Limb Ischemia. Ann Vasc Surg 2017; 41:169-175.e4. [PMID: 28242402 DOI: 10.1016/j.avsg.2016.08.043] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/16/2016] [Accepted: 08/17/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Poor nutritional status has been associated with a higher risk of morbidity and mortality in general surgery patients; however, outcomes in vascular surgery patients are unclear. Our goal was to determine the effect of poor nutritional status on perioperative morbidity and mortality after lower extremity bypass (LEB). METHODS The 2005-2012 National Surgical Quality Improvement Program was analyzed to determine associated complications, mortality, length of stay (LOS), and readmissions for patients with hypoalbuminemia (serum albumin <3.5 g/dL and <2.8 g/dL) undergoing infrainguinal lower extremity bypass for critical limb ischemia. Multivariable analyses were performed to assess associated risk factors while adjusting for possible confounders. RESULTS There were 5,110 LEB identified with an albumin level recorded. There were 2,327 (45.5%) patients with a low preoperative albumin. Patients with a low albumin were more likely to have diabetes, chronic obstructive pulmonary disease, congestive heart failure, previous myocardial infarction, renal failure, dialysis dependence, hypertension, history of transient ischemic attack or stroke, steroid use, impaired functional status, dyspnea at rest, anemia, prior operations within 30 days, preoperative wounds or infections, and a tibial target (P < 0.05). Multivariable analyses showed that low albumin was independently associated with increased mortality (odds ratio [OR]: 1.8, 95% confidence interval [95% CI]: 1.3-2.6, P = 0.001), return to the operating room (OR: 1.4, 95% CI: 1.2-1.6, P < 0.001), and increased LOS (MR: 1.2, 95% CI: 1.1-1.2, P < 0.001). When compared with patients with normal albumin, patients with more severe hypoalbuminemia, less than 2.8 g/dL, showed further increased risk of mortality (OR: 2.5, 95% CI: 1.6-3.8), return to the operating room (OR: 1.6, 95% CI: 1.3-2.0), and prolonged LOS (MR: 1.2, 95% CI: 1.2-1.3). CONCLUSIONS Poor preoperative hypoalbuminemia is associated with morbidity and mortality after infrainguinal lower extremity bypass for critical limb ischemia. Evaluation and optimization of nutritional status should be performed preoperatively in this high risk population.
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Affiliation(s)
- Matthew R Peacock
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA
| | - Mohammad H Eslami
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA
| | - Jeffrey A Kalish
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA
| | - Denis Rybin
- Department of Biostatistics, Boston University, Boston, MA
| | - Gheorghe Doros
- Department of Biostatistics, Boston University, Boston, MA
| | - Nishant K Shah
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA.
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Choi Y. Comment on: Hypoalbuminemia is disproportionately associated with adverse outcomes in obese elective surgical patients. Surg Obes Relat Dis 2014; 11:918-9. [PMID: 25465133 DOI: 10.1016/j.soard.2014.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 10/22/2014] [Accepted: 10/22/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Yong Choi
- Dwight D. Eisenhower Army Medical Center, General Surgery Clinic, Fort Gordon, Georgia.
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Yasuhiro Inoue Y, Toiyama Y, Tanaka K, Mohri Y, Kusunoki M. Consideration of therapeutic approach to advanced colorectal cancer in elderly patients. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2014. [DOI: 10.14319/ijcto.0201.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Nutritional risk index as an independent predictive factor for the development of surgical site infection after pancreaticoduodenectomy. Surg Today 2012; 43:276-83. [DOI: 10.1007/s00595-012-0350-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 01/12/2012] [Indexed: 02/06/2023]
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Kim MS, Kim HK, Kim DY, Ju JK. The influence of nutritional assessment on the outcome of ostomy takedown. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2012; 28:145-51. [PMID: 22816058 PMCID: PMC3398110 DOI: 10.3393/jksc.2012.28.3.145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 06/20/2012] [Indexed: 11/17/2022]
Abstract
Purpose Ostomy takedown is often considered a simple procedure without intention; however, it is associated with significant morbidity. This study is designed to evaluate factors predicting postoperative complications in the ostomy takedown in view of metabolism and nutrition. Methods A retrospective, institutional review-board-approved study was performed to identify all patients undergoing takedown of an ostomy from 2004 to 2010. Results Of all patients (150), 48 patients (32%; male, 31; female, 17) had complications. Takedown of an end-type ostomy showed a high complication rate; complications occurred in 55.9% of end-type ostomies and 15.7% of loop ostomies (P < 0.001). Severe adhesion was also related to a high rate of overall complication (41.3%) (P = 0.024). In preoperative work-up, ostomy type was not significantly associated with malnutrition status. However, postoperatively severe malnutrition level (albumin <2.8 mg/dL) was statistically significant in increasing the risk of complications (72.7%, P = 0.015). In particular, a significant postoperative decrease in albumin (>1.3 mg/dL) was associated with postoperative complications, particularly surgical site infection (SSI). Marked weight loss such as body mass index downgrading may be associated with the development of complications. Conclusion A temporary ostomy may not essentially result in severe malnutrition. However, a postoperative significant decrease in the albumin concentration is an independent risk factor for the development of SSI and complications.
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Affiliation(s)
- Min Sang Kim
- Department of Surgery, Chonnam National University Hospital, Gwangju, Korea
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Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery: a multi-institutional study. Ann Surg 2010; 252:325-9. [PMID: 20647925 DOI: 10.1097/sla.0b013e3181e9819a] [Citation(s) in RCA: 218] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is an infection occurring in an incisional wound within 30 days of surgery and significantly effects patient recovery and hospital resources. OBJECTIVE This study sought to determine the relationship between preoperative serum albumin and SSI. METHODS A study of 524 patients who underwent gastrointestinal surgery in 4 institutions was performed. Patients were identified using a prospective SSI database and hospital records. Serum albumin was determined preoperatively in all patients. Hypoalbuminemia was defined as albumin <30 mg/dL. Data are presented as median (interquartile range) and a difference between groups was examined using Mann-Whitney U and Fisher exact test and multiple logistic regression analysis. RESULTS A total of 105 patients developed a SSI (20%). The median time to the development of SSI was 7 (5-10) days. Having an emergency procedure (P = 0.003), having a procedure over 3 hours in duration (P = 0.047), being American Society of Anaesthetics grade 3 (P = 0.03) and not receiving preoperative antibiotics (P = 0.007) were associated with SSI while having a laparoscopic procedure reduced the likelihood of SSI (P = 0.004). Patients who developed a SSI had a lower preoperative serum albumin (30 [25-34.5] vs. 36 [32-39], P < 0.001). On multivariate analysis, hypoalbuminemia was an independent risk factor for SSI development (relative risk, RR = 5.68, 95% confidence interval: 3.45-9.35, P < 0.001). Albumin <30 mg/dL was associated with an increased rate of deep versus superficial SSI (P = 0.002). The duration of inpatient stay was negatively correlated with preoperative albumin (R = -0.319, P < 0.001). CONCLUSIONS Hypoalbuminemia is an independent risk factor for the development of SSI following gastrointestinal surgery and is associated with deeper SSI and prolonged inpatient stay.
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Kobayashi M, Inoue Y, Mohri Y, Miki C, Kusunoki M. Implementing a standard protocol to decrease the incidence of surgical site infections in rectal cancer surgery. Surg Today 2010; 40:326-33. [PMID: 20339987 DOI: 10.1007/s00595-008-4075-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 10/02/2008] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate the effectiveness of our surgical site infection (SSI) preventive strategies for rectal cancer patients. METHODS We compared the incidences and risk factors for SSI before (1990-1999) and after the implementation of our SSI prevention policies (2002-2006). A total of 250 patients who underwent surgery for rectal cancer were enrolled in this study. Peripheral venous blood samples were obtained perioperatively to measure the circulating pro- and anti-inflammatory cytokines. RESULTS The incidence of SSI was significantly lower after the introduction of SSI prevention policies [SPP(+)] than before [SPP(-)], at 13.1% vs 32.0%, respectively (P = 0.0004). Even with the infection control programs, abdominoperineal resection (APR) was an independent factor predictor of SSI after rectal cancer surgery. The consumption of postoperative interleukin (IL)-6 soluble receptor was much higher in the APR patients than in the non-APR patients. The exaggeration of postoperative IL-6 response was more pronounced in the APR patients in the SPP(+) group than in those in the SPP(-) group, although preoperative chemotherapy and/or radiotherapy might have influenced the inflammatory response. CONCLUSIONS These findings suggest that the introduction of SPP helped reduce the incidence of SSI, especially in the non-APR patients.
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Affiliation(s)
- Minako Kobayashi
- Departments of Innovative Surgery and Surgical Techniques Development, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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Lohsiriwat V, Lohsiriwat D, Boonnuch W, Chinswangwatanakul V, Akaraviputh T, Lert-akayamanee N. Pre-operative hypoalbuminemia is a major risk factor for postoperative complications following rectal cancer surgery. World J Gastroenterol 2008; 14:1248-51. [PMID: 18300352 PMCID: PMC2690674 DOI: 10.3748/wjg.14.1248] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the relationship between pre-operative hypoalbuminemia and the development of complications following rectal cancer surgery, as well as postoperative bowel function and hospital stay.
METHODS: The medical records of 244 patients undergoing elective oncological resection for rectal adenocarcinoma at Siriraj Hospital during 2003 and 2006 were reviewed. The patients had pre-operative serum albumin assessment. Albumin less than 35 g/L was recognized as hypoalbuminemia. Postoperative outcomes, including mortality, complications, time to first bowel movement, time to first defecation, time to resumption of normal diet and length of hospital stay, were analyzed.
RESULTS: The patients were 139 males (57%) and 105 females (43%) with mean age of 62 years. Fifty-six patients (23%) had hypoalbuminemia. Hypoalbuminemic patients had a significantly larger tumor size and lower body mass index compared with non-hypoalbuminemic patients (5.5 vs 4.3 cm; P < 0.001 and 21.9 vs 23.2 kg/m2; P = 0.02, respectively). Thirty day postoperative mortality was 1.2%. Overall complication rate was 25%. Hypoalbuminemic patients had a significantly higher rate of postoperative complications (37.5% vs 21.3%; P = 0.014). In univariate analysis, hypoalbuminemia and ASA status were two risk factors for postoperative complications. In multivariate analysis, hypoalbuminemia was the only significant risk factor (odds ratio 2.22, 95% CI 1.17-4.23; P < 0.015). Hospitalization in hypoalbuminemic patients was significantly longer than that in non-hypoalbuminemic patients (13 vs 10 d, P = 0.034), but the parameters of postoperative bowel function were not significantly different between the two groups.
CONCLUSION: Pre-operative hypoalbuminemia is an independent risk factor for postoperative complications following rectal cancer surgery.
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Ydy LRA, Slhessarenko N, de Aguilar-Nascimento JE. Effect of perioperative allogeneic red blood cell transfusion on the immune-inflammatory response after colorectal cancer resection. World J Surg 2007; 31:2044-51. [PMID: 17671807 DOI: 10.1007/s00268-007-9159-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cytokines play an important role in the acute-phase response to trauma. Few studies have analyzed the effects of allogeneic blood transfusion containing packed red blood cells (RBCs) on the early postoperative immune/inflammatory response after colorectal resection for cancer This study investigated whether allogeneic RBC transfusion influences the postoperative immune/inflammatory response of patients submitted to large bowel resection due to cancer. A total of 26 patients -- 15 men and 11 women, with a median age of 56.5 years (range 24-87 years) -- were prospectively studied. Blood samples were obtained preoperatively and on the first and fourth postoperative days for C-reactive protein (CRP), interleukin-6 (IL-6), and IL-10 assays and for CD4 and CD8 lymphocyte counts. Transfused (> or =3 and <3 units), and nontransfused patients were compared. Both IL-6 and IL-10 increased postoperatively in transfused patients (p < 0.01). The serum IL-6 level was higher in patients receiving > or =3 units of RBCs (p < 0.01). CRP increased postoperatively unrelated to blood transfusion. The CD8 count decreased (p < 0.04) in transfused subjects, whereas CD4 decreased (p < 0.01) only in major-transfusion patients. Perioperative allogeneic RBC transfusion enhances the inflammatory systemic response and decreased immunity in patients submitted to colorectal resection for cancer.
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