Document Detail


Increased hepatosplanchnic inflammation precedes the development of organ dysfunction after elective high-risk surgery.
MedLine Citation:
PMID:  12069179     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
This study investigated the relationship of the hepatosplanchnic production and uptake of inflammatory mediators, hepatosplanchnic perfusion, and outcome during major abdominal surgery to evaluate the hypothesis that regional production of inflammatory mediators precedes the development of hepatic dysfunction. This retrospective analysis of data and blood samples collected during a randomized controlled clinical trial included high-risk surgical patients undergoing major abdominal surgery in a 24-bed university-afilliated intensive care unit. Patients were divided into a subgroup that developed hepatic dysfunction (HD+) postoperatively and a subgroup without hepatic dysfunction (HD-). Hepatic vein and arterial plasma levels of IL-6, IL-8, s-E-selectin, s-ICAM-1, and the TNF-receptors 55 and 75 were measured, and the flux was calculated by multiplying the difference in hepatic vein minus arterial levels of the mediators by the hepatosplanchnic flow. Systemic (thermodilution) and total hepatosplanchnic blood flow (using indocyanine green [ICG]-dilution method) and gastric intramucosal pH (pHi) were assessed preoperatively, 4, 24, and 36 h postoperatively. Of a total of 26 patients, 6 patients developed hepatic dysfunction after their abdominal surgery (mean 6 days postoperatively). The number of sepsis-related deaths and postoperative days on the ventilator were significantly higher in this group. A higher production of IL-8, TNF-receptor-75 and 55 in the hepatosplanchnic area in the HD+ subgroups was found, which preceded the development of organ dysfunction (P = 0.04, P = 0.02, and P = 0.02, respectively). Moreover, the uptake of s-ICAM-1 was significantly increased in this subgroup. Furthermore, total hepatosplanchnic blood flow was significantly higher and pHi was significantly lower in the HD+ group, whereas global hemodynamic data were similar in the two subgroups. In conclusion, the development of postoperative organ dysfunction is preceded by an increased regional inflammatory response, indicated by an increased soluble TNF-receptor shedding and IL-8 production from the hepatosplanchnic area together with an increased uptake of s-ICAM-1. Moreover, an increased total hepatosplanchnic blood flow with intramucosal acidosis was associated with this regional inflammatory response.
Authors:
Martijn Poeze; G Ramsay; W A Buurman; J W M Greve; M Dentener; J Takala
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Shock (Augusta, Ga.)     Volume:  17     ISSN:  1073-2322     ISO Abbreviation:  Shock     Publication Date:  2002 Jun 
Date Detail:
Created Date:  2002-06-18     Completed Date:  2003-01-07     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9421564     Medline TA:  Shock     Country:  United States    
Other Details:
Languages:  eng     Pagination:  451-8     Citation Subset:  IM    
Affiliation:
Department of Surgery, University Hospital Maastricht, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Aged
Cytokines / biosynthesis
Female
Hemodynamics
Humans
Inflammation / etiology*,  immunology,  physiopathology
Inflammation Mediators / metabolism
Liver Circulation
Liver Failure / etiology*,  immunology,  physiopathology
Male
Middle Aged
Postoperative Complications / etiology*,  immunology,  physiopathology
Retrospective Studies
Splanchnic Circulation
Chemical
Reg. No./Substance:
0/Cytokines; 0/Inflammation Mediators

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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