Pre-surgery status determines inflammation levels post-elective surgery

In the present study we quantified a panel of systemic inflammation parameters in patients undergoing elective surgery with a view to evaluate pre-surgical inflammation status in relation to consequences post-surgery. The investigation revealed significantly decreased levels of plasma TNF-α, IL1-β, IL7, IL-8, MIP-1a and IL-1Ra in 79% of patients at 6 hrs post-surgery which have been designated by us a ‘hypo-responsive’ cases and the balance 21% of patients displayed significantly elevated levels of the above cytokines in plasma that have been designated a ‘hyper-responsive’ phenotype by us. Expression of HLA-DR, CD40, CD80, TLR-2, TLR-4 and CD36 on circulating monocytes as shown by multicolour flow-cytometry was significantly decreased post-surgery in hypo-responsive patients. Similarly, PBMCs of hypo-responsive cases responded very poorly in vitro when stimulated with toll-like receptor (TLR) agonists. There was an inverse association between levels of plasma inflammatory cytokines pre-surgery and hypo-responsive consequences post-surgery. Similarly, patients displaying the hyper-responsive phenotype were found to express very low levels of inflammatory cytokines pre-surgery. Taken together the current study offers two novel findings: a) a bimodal inflammatory response post-elective surgery viz., one major cohort displaying hypo-responsive state and another minor group  a hyper-responsive phenotype and b) pre-surgery inflammation status determining the direction of inflammation consequence post-surgery. These findings seem to offer laboratory tools for predicting onset of inflammation post-surgery – considering that SIRS and sepsis are consequences of surgery induced inflammation this study offers predictive indicators for clinical complications post-surgery.