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Polymorphonuclear Leukocyte ActivationAn Early Marker of the Postsurgical Sepsis Response
Christian H. Wakefield;
P. Declan Carey, FRCS(I);
Sharmila Foulds;
John R. T. Monson, MD, FRCS(I);
Pierre J. Guillou, MD, FRCS(Eng)
Arch Surg. 1993;128(4):390-395.
Abstract
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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.
(Arch Surg. 1993;128:390-395)
Author Affiliations
From the Academic Surgical Unit, St Mary's Hospital Medical School, London, England.
Footnotes
Accepted for publication August 23, 1992.
Presented at the 12th Annual Meeting of the Surgical Infection Society, Los Angeles, Calif, April 10, 1992.
Reprint requests to the Academic Surgical Unit, Level 10, Queen Elizabeth the Queen Mother Wing, St Mary's Hospital Medical School, London, England W2 1NY (Dr Guillou).
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