Older Patients Are Immunocompromised by Cytokine Depletion and Loss of Innate Immune Function After HIP Fracture Surgery

Alasdair G Sutherland, Alistair Cook, Clare Miller, Linda Duncan, Raif Yuecel, Steven D Heys, James D Hutchison, Janet Liversidge

Research output: Contribution to journalArticle

Abstract

PURPOSE/INTRODUCTION: We have examined the immune status of elderly patients who underwent surgery for a hip fracture, an injury associated with poor postoperative outcomes, to identify specific immune defects.

METHODS: In a cohort observational study, 16 patients undergoing surgery for hip fractures had immune function evaluation prior to surgery, and then at 3 and 7 days postoperatively, using flow cytometry for phenotype and for monocyte and granulocyte phagocytic function and respiratory burst. Serum samples were stored and batch analyzed using a human cytokine 25-plex panel.

RESULTS: We report significant loss of innate immune function, related specifically to reduced granulocyte numbers by day 7 (P < .0001, flow cytometry; P < .05 white blood cells), and although granulocyte ability to take up opsonized Escherichia coli was increased (P < .05), the ability of those cells to generate a respiratory burst was reduced at days 3 and 7 (P < .05). Monocyte respiratory burst was also significantly reduced (P < .05). Serum cytokine levels indicated very poor T-cell function.

CONCLUSION: We have demonstrated that the antimicrobial immune response is profoundly reduced after surgery in elderly patients with hip fractures. The effect was sustained up to 7 days postoperatively, identifying these patients as particularly vulnerable to bacterial infections.

Original languageEnglish
Pages (from-to)295-302
Number of pages8
JournalGeriatric orthopaedic surgery & rehabilitation
Volume6
Issue number4
Early online date21 Sep 2015
DOIs
Publication statusPublished - Dec 2015

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Immunocompromised Host
Respiratory Burst
Hip Fractures
Granulocytes
Cytokines
Monocytes
Flow Cytometry
Hip Injuries
Serum
Bacterial Infections
Observational Studies
Leukocytes
Cohort Studies
Escherichia coli
T-Lymphocytes
Phenotype

Keywords

  • cellular immunology
  • monocytes
  • innate immunity
  • cytokines
  • T cells

Cite this

Older Patients Are Immunocompromised by Cytokine Depletion and Loss of Innate Immune Function After HIP Fracture Surgery. / Sutherland, Alasdair G; Cook, Alistair; Miller, Clare; Duncan, Linda; Yuecel, Raif; Heys, Steven D; Hutchison, James D; Liversidge, Janet.

In: Geriatric orthopaedic surgery & rehabilitation, Vol. 6, No. 4, 12.2015, p. 295-302.

Research output: Contribution to journalArticle

Sutherland, Alasdair G ; Cook, Alistair ; Miller, Clare ; Duncan, Linda ; Yuecel, Raif ; Heys, Steven D ; Hutchison, James D ; Liversidge, Janet. / Older Patients Are Immunocompromised by Cytokine Depletion and Loss of Innate Immune Function After HIP Fracture Surgery. In: Geriatric orthopaedic surgery & rehabilitation. 2015 ; Vol. 6, No. 4. pp. 295-302.
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AU - Yuecel, Raif

AU - Heys, Steven D

AU - Hutchison, James D

AU - Liversidge, Janet

N1 - Acknowledgments We are grateful to S. S. Baliga and S McKenna for help in recruiting participants for this study, and to Vijitha Sivarasa for technical help in setting up the assays. Funding This work was funded by Joint Action, the orthopaedic research appeal of the British Orthopaedic Association.

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N2 - PURPOSE/INTRODUCTION: We have examined the immune status of elderly patients who underwent surgery for a hip fracture, an injury associated with poor postoperative outcomes, to identify specific immune defects.METHODS: In a cohort observational study, 16 patients undergoing surgery for hip fractures had immune function evaluation prior to surgery, and then at 3 and 7 days postoperatively, using flow cytometry for phenotype and for monocyte and granulocyte phagocytic function and respiratory burst. Serum samples were stored and batch analyzed using a human cytokine 25-plex panel.RESULTS: We report significant loss of innate immune function, related specifically to reduced granulocyte numbers by day 7 (P < .0001, flow cytometry; P < .05 white blood cells), and although granulocyte ability to take up opsonized Escherichia coli was increased (P < .05), the ability of those cells to generate a respiratory burst was reduced at days 3 and 7 (P < .05). Monocyte respiratory burst was also significantly reduced (P < .05). Serum cytokine levels indicated very poor T-cell function.CONCLUSION: We have demonstrated that the antimicrobial immune response is profoundly reduced after surgery in elderly patients with hip fractures. The effect was sustained up to 7 days postoperatively, identifying these patients as particularly vulnerable to bacterial infections.

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