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Preoperative TruCulture® whole blood cytokine response predicts post‐operative inflammation in pancreaticoduodenectomy patients—A pilot cohort study
Author(s) -
Aasvang Eske K.,
Pitter Sandra,
Hansen Carsten P.,
Storkholm Jan H.,
Krohn Paul S.,
Burgdorf Stefan K.,
Von Stemann Jakob H.,
Lundgren Jens D.,
Nielsen Susanne D.,
Kehlet Henrik,
Ostrowski Sisse R.
Publication year - 2020
Publication title -
scandinavian journal of immunology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.934
H-Index - 88
eISSN - 1365-3083
pISSN - 0300-9475
DOI - 10.1111/sji.12930
Subject(s) - medicine , immune system , pancreaticoduodenectomy , gastroenterology , cohort , cytokine , inflammation , surgery , immunology , pancreas
Major surgery is associated with substantial morbidity and mortality with early post‐operative adverse events (POAE) occurring in 30% of patients within the first 30 days. The underlying pathogenesis is multifactorial, including immune dysfunction and increased inflammatory response to surgery. We investigated preoperative immune function by the TruCulture® whole blood technique in a cohort of patients undergoing pancreaticoduodenectomy (PD), hypothesizing that patients developing inflammatory POAE defined as leucocytosis, fever or high (above median) area under the curve (AUC) C‐reactive protein (CRP) the first post‐operative week would display perturbed preoperative immune function. Sixty‐two adult patients were screened, 30 included and 11 excluded post‐inclusion due to other surgical procedures than PD and post‐operative complications directly attributed to surgery, leaving 19 patients for analysis of preoperative immune function. Patients developing leucocytosis (n = 5, 26%) had lower Toll‐like receptor (TLR)‐3–stimulated IL‐12p40 and higher Candida Albicans (TLR1/2/4/6, Dectin‐1)‐stimulated TNF‐α, compared to patients without leucocytosis (all P < .05). Patients developing fever (n = 7, 37%) had lower TLR7/8‐stimulated IFN‐γ and patients with high AUC CRP (n = 9, 47%) had lower TLR3‐stimulated IFN‐γ and IL‐6 and lower TLR7/8‐stimulated IL‐10 (all P < .05), compared to patients without fever or low CRP, respectively. In conclusion, patients with inflammatory POAE displayed lower preoperative stimulated IL‐12p40, IFN‐γ, IL‐6 and IL‐10 and higher TNF‐α response, compared to patients without inflammatory POAE. This finding suggests that TruCulture is a feasible immunologic screening tool in surgical patients, with a potential for preoperative identification of patients at increased risk for inflammatory POAE, allowing for risk‐based intervention trials.