Immunodepression following neurosurgical procedures

Asadullah, Khusru; Woiciechowsky, Christian; Döcke, W D; Liebenthal, Christa; Wauer, Helmar; Kox, Wolfgang J.; Volk, H. D.; Vogel, Siegfried; Baehr, R. von

doi:10.1097/00003246-199512000-00006

Cited by 81 publications

(50 citation statements)

References 27 publications

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“…Although our data indicate that temporary immunodepression is correlated with severity of aSAH, surgical procedures (craniotomy, clipping) may have further affected immune markers. 4 In addition, the role of endogenous stress mediators (catecholamines, glucocorticoids) and medication on immunodepression was not analyzed. Because in most patients no MRI was available, an analysis of the anatomic site of the lesion possibly related to the degree of immunodepression was not performed.…”

Section: Limitations and Perspectivesmentioning

confidence: 99%

Immunodepression After Aneurysmal Subarachnoid Hemorrhage

Sarrafzadeh

Schlenk

Meisel

et al. 2011

Stroke

124

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Background and Purpose-Immunodepression after stroke is associated with complications like high infection rate, but its role in aneurysmal subarachnoid hemorrhage (aSAH) is unclear. This pilot study aimed to assess the presence of immunodepression and its association with infections after aSAH. Methods-Sixteen aSAH patients were enrolled in a prospective study on immune function in a single institution. Detailed immune monitoring (peripheral blood leukocyte subsets, monocyte human leukocyte antigen-DR expression, ex vivo lipopolysaccharide-induced monocytic, Concanavalin A-induced lymphocytic cytokine secretion) was performed until day 10 after aSAH. Occurrence of infection was assessed within 14 days after aSAH. Results-Sixteen consecutive aSAH patients (53.1Ϯ10.2 years; meanϮSD) met the inclusion criteria, classified as asymptomatic (World Federation of Neurological Surgeons; median, 1; quartile, 1-1; nϭ7) and symptomatic (median, 4; quartile, 3-5; nϭ9), all presenting with acute neurological deficits, and 5 of these had additional delayed cerebral ischemia. T-lymphopenia, impaired ex vivo lymphocytic/monocytic cytokine secretion, and decreased monocyte human leukocyte antigen-DR expression occurred over all World Federation of Neurological Surgeons grades but persisted beyond day 3 only in symptomatic patients. Pneumonia (67%; Pϭ0.011) was more frequent in symptomatic patients. Already at day 1, patients with pneumonia showed significantly lower T-cell counts and mitogen-induced interferon-␥ production compared to patients without infections. Conclusions-A pronounced SAH-induced immunodepression was observed early after aSAH but persisted only in symptomatic patients. Immunodepression was associated with a high incidence of pneumonia. Early diagnosis of immunodepression might allow targeted treatment to prevent infectious complications after aSAH. (Stroke. 2011;42:53-58.)

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Section: Limitations and Perspectivesmentioning

confidence: 99%

Immunodepression After Aneurysmal Subarachnoid Hemorrhage

Sarrafzadeh

Schlenk

Meisel

et al. 2011

Stroke

124

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“…Monocyte deactivation seems characterized by a down-regulation of HLA-DR antigen receptor expression, decreased antigen-presenting capacity and impaired TNF-a production upon stimulation with LPS in vitro (5,23). The reduction of HLA-class 11 antigen expression on cell surface has been demonstrated after many surgical procedures,~ncluding neurosurgery, and may involve several cell types, such as B cells, Kupffer cells, splenic macrophages and peritoneal macrophages when hemorrhage conditions occur (24)(25)(26). A key role in monocyte deactivation is played by IL-IO, as it directly decreases HLA-class 11 expression by promoting internalization of these molecules on the surface of monocytes and macrophages.…”

Section: Monocyte and Macrophage Functionmentioning

confidence: 99%

Perioperative Period: Immunological Modifications

Cardinale

Chinellato

Caimmi

et al. 2011

Int J Immunopathol Pharmacol

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Surgical stress induces complex modifications in the hemodynamic, metabolic, neuro-hormonal and immune response ofthe individual. The magnitude ofthese alterations depends on preoperative events leading to surgery, the severity of surgical trauma, and also on post-operative/post-traumatic complications ("multiple hit hypothesis"). As in other conditions of tissue damage, surgery trauma is followed by an immune-inflammatory response, initiated at the site of injury by the innate immune system, followed by a compensatory anti-inflammatory (or immunosuppressive) response (CARS), involving mainly cells of the adaptive immune system, which predispose the host to septic complications. The up-regulated inflammatory response, together with a profound impairment of macrophage and cell-mediated immunity, appear to be the cause for patients' increased susceptibility in developing subsequent sepsis after major surgery.

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“…HLA-DR is one of the key cell surface molecules expressed on monocytes, and is responsible for antigen presentation to T cells and initiation of the infl ammatory cascade during infection [8] . Paradoxically, the expression of HLA-DR on monocytes has been reported to be decreased in adult patients with sepsis after severe trauma and major surgery [9][10][11][12] , and this cell surface molecule has been advocated as an early indicator of immunological deviation associated with the development of severe infection in these patients.…”

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confidence: 99%

“…Reports on adult patients suggested that the decrease in expression of HLA-DR could differentiate patients with sepsis from those who encountered only physical trauma or underwent surgery [9][10][11][12] . This characteristic may theoretically enable infants who acquired perinatal infection to be identifi ed and separated from those who experienced only traumatic delivery.…”

mentioning

confidence: 99%

Quantitative Measurement of Monocyte HLA-DR Expression in the Identification of Early-Onset Neonatal Infection

Ng¹,

Geng

Chui

et al. 2006

Neonatology

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Background: This study aimed to evaluate the diagnostic utilities of monocyte HLA-DR as an infection marker in the identification of early-onset clinical infection and pneumonia in newborn infants. Methods: Term newborns in whom infection was suspected when they were <72 h of age were eligible for enrollment in the study. C-reactive protein (CRP), monocyte HLA-DR and neutrophil CD64 expressions were quantitatively measured at the time of sepsis evaluation (0 h) and 24 h afterwards by flow cytometry and standard laboratory method. Results: A total of 288 infants with suspected sepsis were investigated, and 93 were found to be clinically infected. There were no significant differences in monocyte HLA-DR expression between the infected, non-infected and control groups at 0 h (median (interquartile range): 13,986 (10,994–18,544), 14,234 (12,045–17,474) and 18,441 (14,250–21,537) antibody phycoerythrin (PE) molecules bound/cell), and between infected and non-infected infants at 24 h (median (interquartile range): 17,772 (12,933–25,167) and 19,406 (14,885–24,225) antibody PE molecules bound/cell). The areas under the receiver operating characteristics (ROC) curves for HLA-DR, CD64 and CRP were 0.52–0.54, 0.88–0.94 and 0.75–0.77, respectively. We were unable to determine an optimal cutoff value for HLA-DR, as the diagnostic utilities of any cutoff point on the ROC curves were unable to satisfy the criteria (i.e. sensitivity and specificity ≧80%) for consideration as an useful diagnostic marker of infection. Conclusions: Our findings did not support the use of monocyte HLA-DR alone or in combination with other infection markers in the diagnosis of early-onset clinical infection and pneumonia in term newborns.

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Immunodepression following neurosurgical procedures

Cited by 81 publications

References 27 publications

Immunodepression After Aneurysmal Subarachnoid Hemorrhage

Immunodepression After Aneurysmal Subarachnoid Hemorrhage

Perioperative Period: Immunological Modifications

Quantitative Measurement of Monocyte HLA-DR Expression in the Identification of Early-Onset Neonatal Infection

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