Does age affect liver function and the hepatic acute phase response after major abdominal surgery? View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2001-10-17

AUTHORS

Stefan W. Suttner, Claudia Sürder, Katrin Lang, Swen N. Piper, Bernhard Kumle, Joachim Boldt

ABSTRACT

.Objective: The liver plays a key role in the inflammatory response during major surgery or infection. The influence of age on liver function and hepatic acute phase protein (APP) synthesis should be serially studied in elderly patients undergoing major abdominal surgery.Design and setting: Prospective and descriptive study over 3 days. Clinical investigation in the operating room and surgical intensive care unit (ICU) of a tertiary care hospital.Patients and interventions: 42 consecutive patients were grouped according to age: less than 60 years ("adult") or over 65 years ("elderly") and prospectively studied. All patients received standardized general anesthesia and were treated afterwards according to the standard protocols of our ICU. Intensivists caring for the patients were not involved in the study and were blinded to data analysis.Measurements and results: Concentrations of interleukin (IL)-6, serum amyloid A (SAA), C-reactive protein (CRP), α1-antitrypsin (α1-AT), and haptoglobin were measured to assess the APP response. Liver function was evaluated by the monoethylglycinexylidide (MEGX) test and by measuring alpha-glutathione S-transferase (alpha-GST). All measurements were performed at induction of anesthesia (T0), at the end of surgery (T1), and 2 h (T2), 24 h (T3), and 48 h (T4) postoperatively. There was no difference in the incidence of postoperative septic complications between the two groups. Baseline values of IL-6 and the four APPs were normal in all patients and did not differ between the groups. IL-6 levels increased significantly in all patients at T1 and T2, with a significantly higher increase in the older patients (elderly: from 7.4±3.4 pg/ml to 220.6±49.5 pg/ml; adult: from 6.2±2.5 pg/ml to 189.9±36.8 pg/ml). A return to baseline values was seen at T3 in both groups. Concentrations of all APPs, except for haptoglobin, started to increase at T3. Peak concentrations were significantly lower in the elderly patients (elderly: SAA 358±133 µg/l, CRP 5.1±2.3 mg/dl, α1-AT 160±96 mg/dl; adult: SAA 444±100 µg/l, CRP 8.5±3.2 mg/dl, α1-AT 223±85 mg/dl). Baseline alpha-GST and MEGX concentrations were normal in all patients. Alpha-GST concentrations increased in both groups at T1 and T2, with a significantly higher increase in the older patients (elderly: 3.7±1.4 µg/l to 10.2±2.9 µg/l; adult 4.5±2.1 µg/l to 8.5±1.7 µg/l). A return to baseline values was seen at T3 in both groups. MEGX concentrations were significantly lower and abnormal (<50 ng/ml) in the older patients at T3 and T4.Conclusions: Our observations suggest that the postoperative hepatic acute phase response is reduced in elderly patients undergoing major abdominal surgery. The decreased release of liver-synthesized APPs was associated with an impaired hepatocyte function and a disturbance of hepatocellular integrity. Further work needs to be done to determine whether these findings might have an impact on the incidence of postoperative septic complications or prognostic significance for survival in aged patients. More... »

PAGES

1762-1769

References to SciGraph publications

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00134-001-1126-0

DOI

http://dx.doi.org/10.1007/s00134-001-1126-0

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1050918576

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/11810120


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29 schema:description Abstract.Objective: The liver plays a key role in the inflammatory response during major surgery or infection. The influence of age on liver function and hepatic acute phase protein (APP) synthesis should be serially studied in elderly patients undergoing major abdominal surgery.Design and setting: Prospective and descriptive study over 3 days. Clinical investigation in the operating room and surgical intensive care unit (ICU) of a tertiary care hospital.Patients and interventions: 42 consecutive patients were grouped according to age: less than 60 years ("adult") or over 65 years ("elderly") and prospectively studied. All patients received standardized general anesthesia and were treated afterwards according to the standard protocols of our ICU. Intensivists caring for the patients were not involved in the study and were blinded to data analysis.Measurements and results: Concentrations of interleukin (IL)-6, serum amyloid A (SAA), C-reactive protein (CRP), α1-antitrypsin (α1-AT), and haptoglobin were measured to assess the APP response. Liver function was evaluated by the monoethylglycinexylidide (MEGX) test and by measuring alpha-glutathione S-transferase (alpha-GST). All measurements were performed at induction of anesthesia (T0), at the end of surgery (T1), and 2 h (T2), 24 h (T3), and 48 h (T4) postoperatively. There was no difference in the incidence of postoperative septic complications between the two groups. Baseline values of IL-6 and the four APPs were normal in all patients and did not differ between the groups. IL-6 levels increased significantly in all patients at T1 and T2, with a significantly higher increase in the older patients (elderly: from 7.4±3.4 pg/ml to 220.6±49.5 pg/ml; adult: from 6.2±2.5 pg/ml to 189.9±36.8 pg/ml). A return to baseline values was seen at T3 in both groups. Concentrations of all APPs, except for haptoglobin, started to increase at T3. Peak concentrations were significantly lower in the elderly patients (elderly: SAA 358±133 µg/l, CRP 5.1±2.3 mg/dl, α1-AT 160±96 mg/dl; adult: SAA 444±100 µg/l, CRP 8.5±3.2 mg/dl, α1-AT 223±85 mg/dl). Baseline alpha-GST and MEGX concentrations were normal in all patients. Alpha-GST concentrations increased in both groups at T1 and T2, with a significantly higher increase in the older patients (elderly: 3.7±1.4 µg/l to 10.2±2.9 µg/l; adult 4.5±2.1 µg/l to 8.5±1.7 µg/l). A return to baseline values was seen at T3 in both groups. MEGX concentrations were significantly lower and abnormal (<50 ng/ml) in the older patients at T3 and T4.Conclusions: Our observations suggest that the postoperative hepatic acute phase response is reduced in elderly patients undergoing major abdominal surgery. The decreased release of liver-synthesized APPs was associated with an impaired hepatocyte function and a disturbance of hepatocellular integrity. Further work needs to be done to determine whether these findings might have an impact on the incidence of postoperative septic complications or prognostic significance for survival in aged patients.
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37 C-reactive protein
38 IL-6
39 IL-6 levels
40 MEGX concentrations
41 S-transferase
42 T1
43 T2
44 T3
45 abdominal surgery
46 acute phase response
47 acute-phase protein synthesis
48 age
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50 alpha-GST
51 alpha-GST concentrations
52 alpha-glutathione S-transferase
53 amyloid A
54 analysis
55 anesthesia
56 apps
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58 care hospital
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61 complications
62 concentration
63 concentrations of interleukin
64 consecutive patients
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66 days
67 decreased release
68 descriptive study
69 design
70 differences
71 disturbances
72 elderly patients
73 end
74 end of surgery
75 findings
76 function
77 further work
78 general anesthesia
79 group
80 haptoglobin
81 hepatic acute phase protein synthesis
82 hepatic acute phase response
83 hepatocellular integrity
84 hepatocyte function
85 highest increase
86 hospital
87 impact
88 impaired hepatocyte function
89 incidence
90 increase
91 induction
92 induction of anesthesia
93 infection
94 inflammatory response
95 influence
96 influence of age
97 integrity
98 intensive care unit
99 intensivists
100 interleukin
101 intervention
102 investigation
103 key role
104 levels
105 liver
106 liver function
107 major abdominal surgery
108 major surgery
109 measurements
110 monoethylglycinexylidide test
111 observations
112 older patients
113 operating room
114 patients
115 peak concentration
116 phase response
117 postoperative septic complications
118 prognostic significance
119 protein
120 protein synthesis
121 protocol
122 release
123 response
124 results
125 return
126 role
127 room
128 septic complications
129 serum amyloid A
130 setting
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134 study
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