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

doi:10.1177/2151458515605564

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 journal › Article

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 language	English
Pages (from-to)	295-302
Number of pages	8
Journal	Geriatric orthopaedic surgery & rehabilitation
Volume	6
Issue number	4
Early online date	21 Sep 2015
DOIs	https://doi.org/10.1177/2151458515605564
Publication status	Published - Dec 2015

Keywords

cellular immunology
monocytes
innate immunity
cytokines
T cells

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Cite this

Sutherland, A. G., Cook, A., Miller, C., Duncan, L., Yuecel, R., Heys, S. D., Hutchison, J. D., & Liversidge, J. (2015). Older Patients Are Immunocompromised by Cytokine Depletion and Loss of Innate Immune Function After HIP Fracture Surgery. Geriatric orthopaedic surgery & rehabilitation, 6(4), 295-302. https://doi.org/10.1177/2151458515605564

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 journal › Article

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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.",

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author = "Sutherland, {Alasdair G} and Alistair Cook and Clare Miller and Linda Duncan and Raif Yuecel and Heys, {Steven D} and Hutchison, {James D} and Janet Liversidge",

note = "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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AU - Heys, Steven D

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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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