Predictive value of skin testing, neutrophil migration and C‐reactive protein for postoperative infections in cardiopulmonary bypass patients

Abstract

Despite antibiotic cover for cardiac surgery the development of postoperative infection remains a feared complication. The present prospective study was designed to evaluate whether it is possible to identify preoperatively those individuals in whom the risk of a postoperative infection is significantly greater. Skin test response, chemotaxis and random migration of neutrophils, and serum levels of C-reactive protein (CRP) were chosen as indicators of host resistance. Pre-operatively and at defined postoperative time intervals, 80 patients undergoing open-heart surgery with the aid of cardiopulmonary bypass were examined. Of all the immunological variables measured in this study, the state of anergy proved the most reliable predictor of postoperative infection. Six of the nine pre-operatively anergic patients developed infections (P = 0.00026) representing one half of the postoperatively infected patients. No predictive role of CRP level or neutrophil chemotaxis can be derived from our data. The pre-operatively decreased random migration of polymorphonuclear leukocytes (PMN) from postoperatively infected patients, however, along with the significant defects in chemotactic and random PMN motility seen after cardiac surgery may partly explain the predisposition to bacterial infection in these patients. In conclusion, a pre-operative skin test makes a valuable contribution to the assessment of the patient's postoperative infectious risk.

Potential clinical applications of c‐reactive protein

“…One study has shown preoperative screening CRP measurements in cardiac surgery patients to be predictive of postoperative infectious complications (39). However, these observations have been challenged (65). The CRP test has been proposed as a screen for blood donors (5), but further investigation is necessary.…”

“…The CRP test has been proposed as a screen for blood donors (5), but further investigation is necessary. CRP screening has not been shown to adequately assess ongoing active or chronic disease in the elderly (65). This is possibly due to both the unpredictability of CRP with advancing age and the greater prevalence of inflammatory states in the elderly population.…”

Wound Infections after Cardiac Surgery - a Wound Scoring System may Improve Early Detection

“…Efforts have also been made to nd markers of decreased ability to combat infection (4). In most cases the traditional markers of infection such as fever, leukocytosis, and C-reactive protein (CRP) have proved unreliable (5).…”

Wirkung von Anästhesie und Operation auf wesentliche Immunfunktionen

“…Traumas wurde die Neutrophilen-Migration (16,20,46,49) die Phagozytose (21,83) und die oxidative Mikrobizidie (80) durch die Operation aktiviert (20,21,49) oder jedenfalls nicht gehemmt. Der parallele Anstieg von Granulozy-tenaktivität und Vasopressinantwort bei großen gefißchirurgischen Eingriffen sprechen für eine Assoziation neurohormonaler und neutrophiler Stimulation (49).…”

“…Trotz aller Bemühungen fand sich jedoch kein Zusammenhang zwischen In-vitro-Veränderungen und dem klinischen Verlauf der Patienten. Es bestand aber eine klare Beziehung zwischen präoperativer kutaner Anergie und dem Auftreten postoperativer infektionen (46,48). Somit scheint zumindest bei herzchirurgischen Operationen die Inhibition vor d e m präoperativ bereits disponierte Individuen zu betreffenund nur deren Infektionsrisiko wurde offensichtlich durch die temporäre Immunsuppression signifikant erhöht.…”