Hemorrhage Decreases Macrophage Inflammatory Protein 2 and Interleukin-6 Release

Angele, Martin K.; Knöferl, Markus W.; Schwacha, Martin G.; Ayala, Alfred; Bland, Kirby I.; Cioffi, William G.; Josephson, Stephen L.; Chaudry, Irshad H.

doi:10.1097/00000658-199905000-00007

Cited by 24 publications

(14 citation statements)

References 41 publications

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“…Patients who were hypotensive upon admission were generally more likely to develop hospital-acquired pneumonia, wound infection and bacteremia than normotensive patients [5,7,12,13,16]. Several trials have reported a depression of both the innate and acquired immune system as a result of acute hemorrhage causing an increased susceptibility to infection, SIRS and sepsis in affected patients [15,35]. Angele et al demonstrated that wound exudate cells harvested on the first and third postoperative days from hemorrhaged animals exhibit an impaired release of proinflammatory cytokines and chemokines such as IL-1b and IL-6 in response to a second stimulus (lipopolysaccharide, LPS) in vitro [15].…”

Section: Discussionmentioning

confidence: 99%

“…Several trials have reported a depression of both the innate and acquired immune system as a result of acute hemorrhage causing an increased susceptibility to infection, SIRS and sepsis in affected patients [15,35]. Angele et al demonstrated that wound exudate cells harvested on the first and third postoperative days from hemorrhaged animals exhibit an impaired release of proinflammatory cytokines and chemokines such as IL-1b and IL-6 in response to a second stimulus (lipopolysaccharide, LPS) in vitro [15]. They concluded that this dysfunction of wound exsudate cells could provide a potential mechanism by which to explain the impaired bacterial resistance in wounds of trauma patients, resulting in a higher rate of wound infections.…”

Section: Discussionmentioning

confidence: 99%

“…Peitzman et al [14] demonstrated that the presence of hemorrhagic shock increases the rate of bacterial translocation during hypotension and also the ischemic disruption of the intestinal mucosal barrier, leading to systemic dissemination of intestinal bacteria. Clinical and experimental studies have shown that the rate of wound infection is increased after trauma and hemorrhagic shock [15,16]. Other studies have shown that the requirement of blood transfusion as a surrogate index of hemorrhage is a risk factor for infection following trauma [8,[17][18][19].…”

Section: Introductionmentioning

confidence: 99%

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The Severity of Injury and the Extent of Hemorrhagic Shock Predict the Incidence of Infectious Complications in Trauma Patients

et al. 2009

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Background: Trauma patients are at high risk of developing systemic inflammatory response syndrome (SIRS) and infections. The aim of this study was to evaluate the influence of the severity of injury and the extent of hemorrhagic shock at admission on the incidence of SIRS, infection and septic complications. Methods: A total of 972 patients who had an injury severity score (ISS) of ‡ 17, survived more than 72 h, and were admitted to a level I trauma center within 24 h after trauma were included in this retrospective analysis. SIRS, sepsis and infection rates were measured in patients with different severities of injury as assessed by ISS, or with various degrees of hemorrhagic shock according to ATLS Ò guidelines, and were compared using both uni-and multivariate analysis. Results: Infection rates and septic complications increase significantly (p < 0.001) with higher ISS. Severe hemorrhagic shock on admission is associated with a higher rate of infection (72.8%) and septic complications (43.2%) compared to mild hemorrhagic shock (43.4%, p < 0.001 and 21.7%, p < 0.001, respectively). Conclusions: The severity of injury and the severity of hemorrhagic shock are risk factors for infectious and septic complications. Early diagnostic and adequate therapeutic work up with planned early ''second look'' interventions in such high-risk patients may help to reduce these common posttraumatic complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Severity of Injury and the Extent of Hemorrhagic Shock Predict the Incidence of Infectious Complications in Trauma Patients

et al. 2009

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“…However, cytokines have been shown to be a major information transmission system in the host response to stress, a close relationship has been demonstrated between excessive reaction of pro-inflammatory cytokines and multiple organ failure [4,5]. On the other hand, in response to major stress, nonspecific immunocompetence, such as the level of circulating lymphocyte counts and macrophage activity are known to decrease [6][7][8]. Bone [9] proposed compensatory anti-inflammatory response syndrome (CARS) to describe the state of immunosuppression, as opposed to systemic inflammatory response syndrome (SIRS).…”

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confidence: 99%

Cytokine Profile of Serum and Bronchoalveolar Lavage Fluids following Thoracic Esophageal Cancer Surgery

Sato¹,

Koeda²,

Kimura³

et al. 2001

Eur Surg Res

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Objectives: The body’s response to stress is comprised of two opposing reactions, namely inflammation and immunosuppression. The balance between these two reactions not only changes over time, but also varies among different cells or organs. Limited information is available regarding the cytokine balance of circulating blood and inflammatory sites after thoracic surgical stress. Design: The subjects of the present study were 10 patients undergoing esophageal cancer surgery which requires thoracolaparotomic manipulation. The postoperative levels of interleukin (IL)-8, IL-10, IL-1 receptor antagonist (IL-1ra) and soluble tumor necrosis factor receptor I (sTNF-RI) in bronchoalveolar lavage fluids (BALFs) and peripheral blood were measured by enzyme-linked immunosorbent assay. The absolute concentration of cytokines in lower respiratory tract ([cytokine]_LRT) was estimated by using the ratio of urea concentration in BALF and serum. Results: The levels of these cytokines in peripheral blood peaked within 24 h of start of the surgery (IL-8 85.6 ± 29.8 pg/ml; IL-10 65.1 ± 10.6 pg/ml; IL-1ra 2,807.8 ± 652.8 pg/ml, and sTNF-RI 3,996.3 ± 380.1 pg/ml). The level of [IL-8]_LRT immediately after surgery was approximately 20 times higher than that in peripheral blood, and the level of [IL-1ra]_LRT was approximately 4 times higher. In contrast, the level of [IL-10]_LRT immediately after surgery was comparable to that in peripheral blood, but the level of [sTNF RI]_LRT immediately after surgery was approximately one fifth of that in peripheral blood. Conclusions: The balance between pro- and anti-inflammatory reactions varies from one part of the body to the next, and changes over time after surgery. The profile of stress-induced pro-inflammatory cytokines and anti-inflammatory cytokines should be analyzed further to establish appropriate and effective cytokine modulatory therapeutic approaches.

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“…Indeed, in this study, the number of postoperative circulating T lymphocytes significantly decreased in the control group and did not return to the preoperative values during the study period, but the decrease in the number and in the mitogenic activity of lymphocytes was significantly reduced by UTI. Moreover, the production of TNF-α in whole blood, which has been observed to decrease under stressful conditions such as invasive surgery [13], hemorrhage [14], and sepsis [15], showed an early recovery in the UTI group. These data suggest that a protease-modulating therapy may be a new strategy for dealing with postoperative immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

Influence of a Human Protease Inhibitor on Surgical Stress Induced Immunosuppression

Sato

Endo²,

Kimura³

et al. 2002

Dig Surg

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Background/Aim: Postoperative tissue injury and immunosuppression can occur after major surgery. In this study, we explore the potential benefits of administering a protease inhibitor to treat immunosuppression caused by surgical stress. Methods: Sixteen patients with esophageal cancer were preoperatively allocated at random into two equal groups. A urinary trypsin inhibitor, ulinastatin (UTI), was intravenously administered to the treatment (UTI) group at a dose of 150,000 U every 12 h from the start of surgery until postoperative day 5, whereas the control group received a placebo. One unit of UTI was defined as the amount of UTI necessary to inhibit the activity of 2 µg of bovine pancreatic trypsin by 50%. We measured the plasma levels of polymorphonuclear neutrophil elastase, interleukin 8, circulating T lymphocyte subsets, and mitogenic activity and in vitro production of tumor necrosis factor alpha in lipopolysaccharide-stimulated whole blood. Results: The postoperative serum value of polymorphonuclear neutrophil elastase was significantly lower in the UTI group, but the interleukin 8 concentrations did not significantly vary between the two groups. On the other hand, the severity of the postoperative immunosuppression was reduced in the UTI group, and immune functions, such as the numbers of T lymphocytes, the mitogenic activity of lymphocytes, and the level of tumor necrosis factor alpha production in whole blood, recovered significantly earlier in the UTI group. Conclusion: These data suggest that a protease-modulating therapy may be a new strategy for the treatment of surgical stress induced immune dysfunction.

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Hemorrhage Decreases Macrophage Inflammatory Protein 2 and Interleukin-6 Release

Cited by 24 publications

References 41 publications

The Severity of Injury and the Extent of Hemorrhagic Shock Predict the Incidence of Infectious Complications in Trauma Patients

The Severity of Injury and the Extent of Hemorrhagic Shock Predict the Incidence of Infectious Complications in Trauma Patients

Cytokine Profile of Serum and Bronchoalveolar Lavage Fluids following Thoracic Esophageal Cancer Surgery

Influence of a Human Protease Inhibitor on Surgical Stress Induced Immunosuppression

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