Burhan APİLİOĞULLARI, Hıdır ESME, Banu YOLDAŞ, Taha BEKÇİ, Recep KEŞLİ, Mustafa ÇALIK

Evaluation of procalcitonin, interleukin 6, and tumor necrosis factor alpha levels as early markers of postoperative complications following major thoracic surgery

Amaç: Bu prospektif çalışmada majör göğüs cerrahisi uygulanan hastalarda ameliyat sonrası komplikasyon riski ile sistemik inflamasyan arasındaki birliktelik araştırıldı. Çalışma planı: Akciğer rezeksiyonu için torakotomi uygulanan 37 hasta (23 erkek, 14 kadın; ort yaş 53.9 yıl; dağılım 44-72 yıl) çalışmaya dahil edildi. Serum prokalsitonin, interlökin 6 (IL-6) ve tümör nekroz faktör alfa (TNF-a) konsantrasyonları cerrahi öncesi ve cerrahi sonrası bir, beş ve yedinci günlerde ölçüldü. Demografik bilgiler, torakotomi nedenleri, akciğer rezeksiyon tipi, ameliyat süresi, hastanede kalış süresi ve ameliyat sonrası komplikasyonlar kaydedildi. Bulgular: Ameliyat sonrası serum prokalsitonin, IL-6 ve TNF-a konsantrasyonları ameliyat öncesi değerler ile karşılaştırıldığında anlamlı olarak daha yüksek idi. Ameliyat sonrası komplikasyonlu hastalar, komplikasyon gelişmeyen hastalar ile karşılaştırıldığında ameliyat sonrası bir ve beşinci günlerde prokalsitonin seviyesi yaklaşık üç kat, ameliyat sonrası yedinci gün IL-6 seviyesi iki kat yüksek idi. Ameliyat sonrası bir ve beşinci günlerde prokalsitonin, ameliyat sonrası yedinci gün IL-6 düzeylerinde, ameliyat sonrası komplikasyon olan ve olmayan gruplar arasında anlamlı fark vardı. Sonuç: Ameliyat sonrası birinci gün yükselmiş prokalsitonin seviyesi ameliyat sonrası komplikasyonların ümit verici erken bir göstergesidir. Ameliyat sonrası dönemde prokaksitonin, IL-6 ve TNF-a konsantrasyonlarının yükselmesi cerrahi travmanın ciddiyetinin göstergesidir. Bu bulgular tetikte olmamızı ve ileri incelemelerde bulunmamıza yardımcı olabilir.

Majör torasik cerrahi sonrası komplikasyonların erken belirteçleri olarak prokalsitonin, interlökin 6 ve tümör nekroz faktör alfanın değerlendirilmesi

Background: This prospective study aims to investigate the association between systemic inflammation and risk for postoperative complications in patients undergoing major thoracic surgery. Methods: Thirty-seven patients (23 males, 14 females; mean age 53.9 years; range 44 to 72 years) undergoing thoracotomy for lung resection were included. Serum procalcitonin, interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-a) concentrations were measured at baseline and on the first, fifth and seventh day following surgery. Demographic data, reasons for thoracotomy, type of lung resection, duration of surgery, length of hospital stay, and postoperative complications were recorded. Results: Serum concentrations of procalcitonin, IL-6, and TNF-a after surgery were significantly higher compared to the preoperative values. Patients with postoperative complications had approximately a three-fold elevation in procalcitonin levels at postoperative days one and five, and a two-fold elevation in IL-6 levels at postoperative day seven, compared to patients without pulmonary complications. The procalcitonin levels on postoperative days one and five and IL-6 levels on postoperative day seven were significantly different between the groups with and without postoperative complications. Conclusion: An elevated procalcitonin level on postoperative day one is a promising early marker of postoperative complications. Elevated concentrations of procalcitonin, IL-6, and TNF-a in the postoperative period are markers of the severity of surgical injury. These findings may contribute to alert us and make further examinations.

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1.Brunelli A, Sabbatini A, Xiume F, Borri A, Salati M, Marasco RD, et al. Inability to perform maximal stair climbing test before lung resection: a propensity score analysis on early outcome. Eur J Cardiothorac Surg 2005;27:367-72.
2.Motta G, Ratto GB. Complications of surgery in the treatment of lung cancer: their relationship with the extent of resection and preoperative respiratory function tests. Acta Chir Belg 1989;89:161-5.
3.Nagasaki F, Flehinger BJ, Martini N. Complications of surgery in the treatment of carcinoma of the lung. Chest 1982;82:25-9.
4.Amar D, Zhang H, Park B, Heerdt PM, Fleisher M, Thaler HT. Inflammation and outcome after general thoracic surgery. Eur J Cardiothorac Surg 2007;32:431-4.
5.Szczesny TJ, Slotwinski R, Stankiewicz A, Szczygiel B, Zaleska M, Kopacz M. Interleukin 6 and interleukin 1 receptor antagonist as early markers of complications after lung cancer surgery. Eur J Cardiothorac Surg 2007;31:719-24.
6.Moore FD: Metabolic care of the surgical patient. Philadelphia; W.B. Saunders; 1959.
7.Avdagic SS, Krdzalic G, Avdagic H, Uljic V, Piric M. Effects of postoperative analgesia on acute phase response in thoracic surgery. Med Arh 2010;64:113-5.
8.Kuda T, Kamada Y, Nagamine N, Oshiro J, Kuniyoshi M, Genka K, et al. Evaluation of inflammatory-response-induced thoracoscopic surgical stress. Jpn J Thorac Cardiovasc Surg 2002;50:206-9.
9.Mokart D, Merlin M, Sannini A, Brun JP, Delpero JR, Houvenaeghel G, et al. Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after major surgery. Br J Anaesth 2005;94:767-73.
10.Yamada T, Hisanaga M, Nakajima Y, Kanehiro H, Watanabe A, Ohyama T, et al. Serum interleukin-6, interleukin-8, hepatocyte growth factor, and nitric oxide changes during thoracic surgery. World J Surg 1998;22:783-90.
11.Biffl WL, Moore EE, Moore FA, Peterson VM. Interleukin-6 in the injured patient. Marker of injury or mediator of inflammation? Ann Surg 1996;224:647-64.
12.Mokart D, Capo C, Blache JL, Delpero JR, Houvenaeghel G, Martin C, et al. Early postoperative compensatory anti- inflammatory response syndrome is associated with septic complications after major surgical trauma in patients with cancer. Br J Surg 2002;89:1450-6.
13.Reith HB, Mittelkötter U, Debus ES, Küssner C, Thiede A. Procalcitonin in early detection of postoperative complications. Dig Surg 1998;15:260-5.
14.Harbarth S, Holeckova K, Froidevaux C, Pittet D, Ricou B, Grau GE, et al. Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med 2001;164:396-402.
15.Hensel M, Vol k T, Dö cke W D, Ker n F, Tsch i r na D, Egerer K, et al. Hyperprocalcitonemia in patients with noninfectious SIRS and pulmonary dysfunction associated with cardiopulmonary bypass. Anesthesiology 1998;89:93-104.
16.Mimoz O, Benoist JF, Edouard AR, Assicot M, Bohuon C, Samii K. Procalcitonin and C-reactive protein during the early posttraumatic systemic inflammatory response syndrome. Intensive Care Med 1998;24:185-8.
17.Meisner M, Tschaikowsky K, Hutzler A, Schick C, Schüttler J. Postoperative plasma concentrations of procalcitonin after different types of surgery. Intensive Care Med 1998;24:680-4.
18.Falcoz PE, Laluc F, Toubin MM, Puyraveau M, Clement F, Mercier M, et al. Usefulness of procalcitonin in the early detection of infection after thoracic surgery. Eur J Cardiothorac Surg 2005;27:1074-8.