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The serum interleukin 6 (IL-6) response to elective surgery
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THE SERUM INTERLEURIN6 (IL-6)RESPONSE TO ELECTIVE SURGERY. A Shenkin,W D Fraser, J D Series, H J G Burns, J Van Damne, Departmentsof Biochemistryand Surgery, Glasgow Royal Infirmaryand Rega Institute,Leuven.
IL-6 (B cell stimulatingfactor 2, interferon62) is a cytokinewhich may be involved in the control of the acute phase protein response to trauma. The kinetics of IL-~ release in relation to acute phase proteins has not been established. We have investigatedchanges in serum IL-6 followingcholecystectomy(6 patients) and resection of colonic neoplasm (5 patients). Multiple venous blood samples were taken before, during and after operation. Serum was analysed for IL-6 by hybridomagrowth stimulationassay using purified IL-6 as standard. 1 unit IL-6 produces half maximal stimulationand is approximately1 pg. C-reactiveprotein (CRP) was measured by fluorescencepolarisation. Plasma was also analysed for IL-1 by a two cell bioassay (LBRM/HTzA)and for tumour necrosis factor (TNF) by L929 cytolysisassay. Serum IL-6 increasedin all patients within 1 hour of incision,reachinga maximum between 2-4 hours after incision for cholecystectomy(median58 U/ml: range 23-110 U/ml) and between 4-8 hours after incision for colorectalsurgery (median80 U/ml; range 4O290 U/ml) (not significant:Mann-WhitneyTest). The maximum IL-6 correlatedwith length of operation (cholecystectomy r=0.75; colonic resectionr=0.93; overall r=0.76). Serum CRP was detectable (>lO nq/l) by 8-12 hours of incision, maximum concentrations berng reached by 36-48 hours in both groups. Maximum serum CRP did not correlatewith maximum serum IL-6 concentrationor length of operation. There was no consistentincrease in plasma IL-1 or TNF followingsurgery, although some pre- and post-operationsamples had detectable IL-l. We conclude that serum IL-6 increasesrapidly followingelective surgery, that this may be related to the magnitude of the surgery, and this precedes the rise in serum acute phase proteins.
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THE POST OPERATIVE ACUTE PHASE RESPONSE IS UNINFLUENCED BY NUTRITIONAL STATUS. A T Boyd, G A Young, M J McMahon, University Department of Surgery, The General Infirmary, Leeds, UK. The acute phase response is attenuated by protein deprivation in experimental animals and total hepatic protein synthesis is reduced in patients who have lost weight. It has been suggested, however, that acute phase protein synthesis in man is independent of nutritional status. . To assess the effect of nutritional status on the magnitude of the postoperative acute phase plasma protein response we studied C-reactive protein (CRP), an acute phase reactant whose plasma level usually peaks approximately 48 hours after the initiating stimulus. Plasma levels were measured, by laser nephalometry, daily for 3 days after radical resection for gastro-oesophageal cancer. Twenty eight patients were studied. No significant correlations were found, using Spearman's rank order correlation coefficient, between peak (48hr) plasma CRP and age (r = -0.28, p = 0.08), weight (r = 0.34, p = 0.09), weight loss (r = -0.39, p = 0.70), mid arm circumference (r = 0.36, p = 0.06), triceps skinfold thickness (r = 0.18, p = 0.39), duration of operation (r = 0.25, p = P ?O), or preoperative albumin (r = 0.14, p = 0.48). When divided into two groups on the basis of weight loss (<7.5%, n=17; >7.5%, n = ll), there was no difference between 48hr plasma CRP in the two groups (median 13.4 v 13.5 mg/dl, Mann-Whitney U test). This data suggests that acute phase protein synthesis in response to a major operation is preferentially maintained during malnutrition at the expense of albumin and other transport proteins.
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THE SERUM INTERLEURIN6 (IL-6)RESPONSE TO ELECTIVE SURGERY. A Shenkin,W D Fraser, J D Series, H J G Burns, J Van Damne, Departmentsof Biochemistryand Surgery, Glasgow Royal Infirmaryand Rega Institute,Leuven.
IL-6 (B cell stimulatingfactor 2, interferon62) is a cytokinewhich may be involved in the control of the acute phase protein response to trauma. The kinetics of IL-~ release in relation to acute phase proteins has not been established. We have investigatedchanges in serum IL-6 followingcholecystectomy(6 patients) and resection of colonic neoplasm (5 patients). Multiple venous blood samples were taken before, during and after operation. Serum was analysed for IL-6 by hybridomagrowth stimulationassay using purified IL-6 as standard. 1 unit IL-6 produces half maximal stimulationand is approximately1 pg. C-reactiveprotein (CRP) was measured by fluorescencepolarisation. Plasma was also analysed for IL-1 by a two cell bioassay (LBRM/HTzA)and for tumour necrosis factor (TNF) by L929 cytolysisassay. Serum IL-6 increasedin all patients within 1 hour of incision,reachinga maximum between 2-4 hours after incision for cholecystectomy(median58 U/ml: range 23-110 U/ml) and between 4-8 hours after incision for colorectalsurgery (median80 U/ml; range 4O290 U/ml) (not significant:Mann-WhitneyTest). The maximum IL-6 correlatedwith length of operation (cholecystectomy r=0.75; colonic resectionr=0.93; overall r=0.76). Serum CRP was detectable (>lO nq/l) by 8-12 hours of incision, maximum concentrations berng reached by 36-48 hours in both groups. Maximum serum CRP did not correlatewith maximum serum IL-6 concentrationor length of operation. There was no consistentincrease in plasma IL-1 or TNF followingsurgery, although some pre- and post-operationsamples had detectable IL-l. We conclude that serum IL-6 increasesrapidly followingelective surgery, that this may be related to the magnitude of the surgery, and this precedes the rise in serum acute phase proteins.
0.38
THE POST OPERATIVE ACUTE PHASE RESPONSE IS UNINFLUENCED BY NUTRITIONAL STATUS. A T Boyd, G A Young, M J McMahon, University Department of Surgery, The General Infirmary, Leeds, UK. The acute phase response is attenuated by protein deprivation in experimental animals and total hepatic protein synthesis is reduced in patients who have lost weight. It has been suggested, however, that acute phase protein synthesis in man is independent of nutritional status. . To assess the effect of nutritional status on the magnitude of the postoperative acute phase plasma protein response we studied C-reactive protein (CRP), an acute phase reactant whose plasma level usually peaks approximately 48 hours after the initiating stimulus. Plasma levels were measured, by laser nephalometry, daily for 3 days after radical resection for gastro-oesophageal cancer. Twenty eight patients were studied. No significant correlations were found, using Spearman's rank order correlation coefficient, between peak (48hr) plasma CRP and age (r = -0.28, p = 0.08), weight (r = 0.34, p = 0.09), weight loss (r = -0.39, p = 0.70), mid arm circumference (r = 0.36, p = 0.06), triceps skinfold thickness (r = 0.18, p = 0.39), duration of operation (r = 0.25, p = P ?O), or preoperative albumin (r = 0.14, p = 0.48). When divided into two groups on the basis of weight loss (<7.5%, n=17; >7.5%, n = ll), there was no difference between 48hr plasma CRP in the two groups (median 13.4 v 13.5 mg/dl, Mann-Whitney U test). This data suggests that acute phase protein synthesis in response to a major operation is preferentially maintained during malnutrition at the expense of albumin and other transport proteins.
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