Major surgery is associated with substantial morbidity and mortality with early post‐operative adverse events (POAE) occurring in 30% of patients within the first 30 days. The underlying pathogenesis is multifactorial, including immune dysfunction and increased inflammatory response to surgery. We investigated preoperative immune function by the TruCulture® whole blood technique in a cohort of patients undergoing pancreaticoduodenectomy (PD), hypothesizing that patients developing inflammatory POAE defined as leucocytosis, fever or high (above median) area under the curve (AUC) C‐reactive protein (CRP) the first post‐operative week would display perturbed preoperative immune function. Sixty‐two adult patients were screened, 30 included and 11 excluded post‐inclusion due to other surgical procedures than PD and post‐operative complications directly attributed to surgery, leaving 19 patients for analysis of preoperative immune function. Patients developing leucocytosis (n = 5, 26%) had lower Toll‐like receptor (TLR)‐3–stimulated IL‐12p40 and higher Candida Albicans (TLR1/2/4/6, Dectin‐1)‐stimulated TNF‐α, compared to patients without leucocytosis (all P < .05). Patients developing fever (n = 7, 37%) had lower TLR7/8‐stimulated IFN‐γ and patients with high AUC CRP (n = 9, 47%) had lower TLR3‐stimulated IFN‐γ and IL‐6 and lower TLR7/8‐stimulated IL‐10 (all P < .05), compared to patients without fever or low CRP, respectively. In conclusion, patients with inflammatory POAE displayed lower preoperative stimulated IL‐12p40, IFN‐γ, IL‐6 and IL‐10 and higher TNF‐α response, compared to patients without inflammatory POAE. This finding suggests that TruCulture is a feasible immunologic screening tool in surgical patients, with a potential for preoperative identification of patients at increased risk for inflammatory POAE, allowing for risk‐based intervention trials.

中文翻译：

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术前TruCulture®全血细胞因子反应可预测胰十二指肠切除术患者的术后炎症-一项队列研究。

大手术与大量发病率和死亡率相关，在术后30天内有30％的患者发生早期术后不良事件（POAE）。潜在的发病机制是多因素的，包括免疫功能障碍和对手术的炎症反应增加。我们通过TruCulture®全血技术在接受胰十二指肠切除术（PD）的患者队列中研究了术前免疫功能，并假设发展为炎症性POAE的患者定义为白细胞增多，发烧或曲线下面积（AUC）C高反应区术后第一周的CRP会显示术前免疫功能紊乱。筛选了62名成年患者，由于PD以外的其他外科手术以及直接归因于手术的术后并发症，包括30例患者和11例患者被排除在术后，仅剩下19例患者需要进行术前免疫功能分析。发生白细胞增多症的患者（n = 5，26％）具有较低的Toll样受体（TLR）-3刺激的IL-12p40和较高的水平与没有白细胞增多症的患者相比，白色念珠菌（TLR1 / 2/4/6，Dectin-1）刺激的TNF-α（所有P  <.05）。发烧患者（n = 7，37％）的TLR7 / 8刺激的IFN-γ较低，而AUC CRP高的患者（n = 9，47％）的TLR3刺激的IFN-γ和IL-6较低，TLR7较低/ 8-刺激的IL-10（全P <.05），分别与无发热或低CRP的患者相比。总之，与没有炎症性POAE的患者相比，具有炎症性POAE的患者术前刺激的IL-12p40，IFN-γ，IL-6和IL-10较低，而TNF-α的应答较高。这一发现表明，TruCulture是外科手术患者的一种可行的免疫学筛查工具，具有潜在的术前识别高发炎性POAE风险的患者的潜力，因此可以进行基于风险的干预试验。