Systemic Inflammatory Cytokines Predict the Infectious Complications but Not Prolonged Postoperative Ileus after Colorectal Surgery

G S A Boersema, Z Wu, A G Menon, G J Kleinrensink, J Jeekel, J F Lange, G S A Boersema, Z Wu, A G Menon, G J Kleinrensink, J Jeekel, J F Lange

Abstract

Aim: Postoperative ileus (POI) is common after surgery. Animal studies indicate that the POI mechanism involves an inflammatory response, which is also activated during postoperative complications. This study aimed to determine whether inflammatory biomarkers might facilitate an early detection of prolonged POI (PPOI) or infectious complications.

Methods: Forty-seven adult patients who underwent oncological colorectal surgery were included. They filled out a perioperative diary to report their gastrointestinal symptoms. Blood samples were collected preoperatively, and on postoperative day (POD) 1 and 3. Levels of leucocytes, C-reactive protein (CRP), interleukin (IL)-6, TNF-α, and IL-1β were analyzed.

Results: Patients with PPOI had significantly longer stay in hospital than patients without (13.6 ± 10.5 versus 7.4 ± 3.2 days, p < 0.001); they also had higher levels of IL-6 ratios, leucocytes, and CRP levels, but did not reach significance. Higher levels of postoperative IL-6 and CRP levels (p < 0.05, resp.) were found in patients with infectious complications. The receiver operating characteristic (ROC) analysis found better diagnostic values of IL-6 ratio on both POD 1 and 3 than that of CRP (POD 1: ROC 0.825, p < 0.001).

Conclusion: Blood levels of inflammatory cytokines cannot predict PPOI after colorectal surgery. Instead, postoperative IL-6 changes may predict the infectious complications with a better diagnostic value than the current leukocytes or CRP tests.

Figures

Figure 1
Figure 1
(a) and (b). IL-6 ratio in normal recoveries (non-PPOI) versus PPOI patients, every single dot represents a patient, the line indicates the median, and there are no significant differences.
Figure 2
Figure 2
The leucocyte count and CRP and VAS scores in non-PPOI patients versus PPOI. In panels (a) and (b), bars represent the mean and error bars the SD. There are no significant differences. Panel (c) presents the VAS (visual analogue scale for pain) score, from postoperative day 1 up to postoperative day 6. Panel (d) presents patients with or without PPOI and the time in days of being ready for discharge. Patients with PPOI had a significantly longer hospital stay p < 0.001.
Figure 3
Figure 3
Comparison of IL-6, leucocyte count, and CRP between the patient group with infectious complication(s) (SSI, AL, pneumonia, UWI) and without infectious complication or with or without SSI (surgical site infection) or with or without CAL (colorectal anastomotic leakage). Panel (a) shows that all IL6 ratios are significant higher on both time points between all three groups; the infectious group POD 1 p < 0.001 and POD 3 p = 0.001, SSI; POD 1 p = 0.001 and POD 3 p = 0.017, CAL; POD 1 p = 0.027 and POD 3 p = 0.050. (b) On POD 1 and POD 3, the CRP levels were significantly higher in the infectious complication groups (POD 1 p = 0.009, POD 3 p = 0.008). In the SSI groups, CRP levels were significantly higher in patients with SSI compared to patients without SSI on POD 1, p < 0.001. Also in the groups with CAL had higher numbers of CRP though not significant. (c) Although the leucocyte count is higher in the infectious and CAL groups, there were no significant differences. Bars represent the mean, error bars, and the SD; p values are indicated with an asterisk; ∗p value ≤ 0.05, ∗∗p value ≤ 0.001.
Figure 4
Figure 4
ROC analysis showed CRP and IL-6 ratio on POD 1 (a) and POD 3 (b), on both days; the AUC was higher in IL-6 ratio.

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