Change of Interleukin-17A and its diagnostic value of sepsis in patients with major operations
Date Issued
2014
Date
2014
Author(s)
Cheng, Kuang-Hua
Abstract
Purpose:
Timely identification of septic complication is important for post-surgery patients. However, systemic inflammatory response syndrome secondary to surgical tissue damage can induce fever and leukocytosis. Thus trigger of infection workup and diagnosis of post-operation sepsis are difficult and confusing. In this study, we investigated the change and diagnostic value of pro-inflammatory interleukin-17A (IL-17A) in patients with major operations.
Methods:
This is a prospective observatory study in surgical intensive care unit. Patients’ plasmas were collected before and after the major operations. Body fluids from drainage tube, including pleural, peritoneal or cerebral-spinal fluid were collected every 4 hours on the first day after the operation. The IL-17A and relative interleukin were measured by Bio-RadR bead-based Multiplex assay (detection limit of IL-17A:0.1-24512pg/ml). Clinical data such as white blood cell count、fever days、and infectious complication were recorded. Plasma and drainage fluid were checked again when fever was noted 48 hours after the surgery.
Results:
Ninety patients with informed consent were enrolled, and their mean age was 61.8±12.5 years-old(range:27-89). 48 patients underwent video-assisted thoracoscopic surgery, 1 had external ventricular drain after intracranial hemorrhage, and 41 patients had abdominal operations.
For patients with malignancy of lung, liver or esophagus, IL-17A was detected in plasma before the operation (range: 0-7.06 pg/ml), and the concentration decreased after the cancer resection (p=0.0487). IL-17A in the drainage fluid (range: 0-21.33pg/ml) was noted on the first day after the major operation, and reached peak concentration at 8-12 hours. For patients had septic complications, their IL-17A in the drainage fluid tended to increase rather than decrease at 12-24 hours after the operation. After abdominal operations 48 hours, the febrile patients complicated with intra-abdominal infection following bile or intestine leak had significant higher IL-17A in the drainage fluid compared to patients with extra-abdominal infections such as ventilator-associated pneumonia or catheter-related blood stream infection (median 23.45 vs. 10.41pg/ml, p=0.0066). Peritoneal drainage IL-17A >14.4pg/ml helped diagnosis of gastro-intestine leak and sepsis (sensitivity: 100%, specificity: 83.33%).
Concentration of IL-17A in the drainage fluid did not correlate significantly with serum IL-17A、 operation duration、 blood loss or post-operation white cell count. For patients with recurred fever 48 hours after operations, their IL-17A in the drainage fluid correlated significantly with concentration of IL-1s(rho=0.686, p=0.0004) and IL-22(rho=0.739, p=0.0003)。
Conclusion:
Minimal concentration of IL-17A in the drainage fluid was detected in patients with major operation. From 12 to 24 hours after the operation, increasing IL-17A in the drainage fluid inferred septic complications Monitoring IL-17A in drainage fluid is non-invasive and aid early identification of focal infections. IL-17A >14.4 pg/ml in the peritoneal drainage fluid helps diagnosis of intra-abdominal infections. Secretion of IL-17A after operation correlated with IL-1s and IL-22. IL-17A was detectable in serum of patients with malignancy, and the concentration decreased after the resection of cancer.
Subjects
外科手術
敗血症
全身發炎反應
介白素17A
介白素1s
介白素22
SDGs
Type
thesis
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