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01.12.2014 | original article | Ausgabe 23-24/2014

Wiener klinische Wochenschrift 23-24/2014

Postoperative immunosuppression markers and the occurrence of sepsis in patients with benign and malignant disease

Wiener klinische Wochenschrift > Ausgabe 23-24/2014
MD, PhD Tamara Alkhamis, MD, PhD Dubravka Ivić, PhD Jasenka Wagner, MD, PhD Josip Ivić, MSc Medical Biochemistry Blaženka Dobrošević, MD Ivana Turina, MSc Mathematics Kristina Kralik, MD, PhD Jerko Barbić
Wichtige Hinweise
Tamara Alkhamis and Dubravka Ivić contributed equally to this work.This research was supported by the Ministry of Science, Education and Sports of the Republic of Croatia, Grant number219-0000000-3362.



To investigate associations between the postoperative immune response and the levels of extracellular circulating DNA (cDNA), C-reactive protein (CRP), neutrophil/lymphocyte (N/L) ratio, and regulatory T (Treg) cells in the peripheral blood and their role as potential predictors of postoperative septic complications.


This was a prospective observational study involving 115 adult patients who underwent elective surgery. Patients were divided into three groups: with benign disease, with malignant disease, and with malignant disease and administration of dexamethasone. Serum CRP levels, N/L ratio, monocyte human leukocyte antigen-DR (HLA-DR) expression, proportion of Treg cells, and cDNA levels were measured at different time points before and after surgery.


All patients had increased CRP levels after surgery. Septic patients had higher serum CRP levels at baseline. Compared with the other groups, the dexamethasone group had significantly higher CRP levels before and after surgery, a significantly higher N/L ratio before surgery, a significantly lower rise in the N/L ratio after surgery, and a significantly lower HLA-DR expression at baseline, which remained stable after surgery. In the malignant-disease group, we observed a significant postoperative decrease in the HLA-DR expression.


Our results suggest that the immunosuppressive effect of surgery and the presence of a malignant disease may contribute to a higher risk of postoperative sepsis. Preoperative CRP levels may be a reliable predictor of sepsis in oncological patients.

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