Circulating cytokines, chemokines, and stress hormones are increased in patients with organ dysfunction following liver resection

Preoperative jaundice was associated with significantly higher IL-6 levels in the first hours after resection and on POD1.

“Preoperative jaundice was associated with significantly higher IL-6 levels in the first hours after resection [20,23] and on POD1 [22], as were intraoperative blood transfusions [22].”

Intraoperative blood transfusions were associated with significantly higher IL-6 levels.

“Preoperative jaundice was associated with significantly higher IL-6 levels in the first hours after resection [20,23] and on POD1 [22], as were intraoperative blood transfusions [22].”

Longer surgeries and major hepatectomies resulted in higher IL-6 values immediately after the end of the operation.

“Also, longer surgeries and major hepatectomies resulted in higher IL-6 values immediately after the end of the operation [22,23], while in one study, there was no apparent correlation of extend of resection with postoperative IL-6 levels [31].”

The review included 12 publications with a collective 589 patients, with a range of 14 to 128 patients.

“A final number of 12 publications with a collective 589 patients (range 14–128) were included in this review (Table 1) [20,21,22,23,24,25,26,27,28,29,30,31].”

In Kimura et al. 2006, IL-6 was significantly higher on POD1 in cases with subsequent postoperative infections or any organ dysfunction.

“IL-6 was significantly higher on POD1 in cases with subsequent postoperative infections (including intraabdominal abscess, pneumonia, wound infection, bacteremia, and cholangitis) or any organ dysfunction (respiratory, liver, renal, cardiovascular, hematologic, neurological).”

In Kimura et al. 2006, multivariable logistic regression suggested that the IL-6 level on POD1 was a significant, independently associated variable for incident postoperative infections and any organ dysfunction.

“However, multivariable logistic regression suggested that the IL-6 level on POD1 was a significant, independently associated variable for incident postoperative infections, as well as any organ dysfunction.”

In Kimura et al. 2006, POD1 IL-6 levels were 401 pg/mL in patients with no infections or organ dysfunction versus 1027 pg/mL in those with organ dysfunction (p < 0.01) and 598 pg/mL with infectious complications (p < 0.05).

“Particularly, POD1 IL-6 levels were 401 pg/mL in patients with no infections/organ dysfunction versus 1027 pg/mL in those with organ dysfunction (p < 0.01) and 598pg/mL with infectious complications (p < 0.05).”

Overproduction of IL-6 potentially indicates an overwhelming systemic inflammatory response syndrome (SIRS), resulting in organ failure, an impaired immune system, and consecutive severe infections.

“Overproduction of IL-6 potentially indicates an overwhelming systemic inflammatory response syndrome (SIRS), resulting in organ failure, an impaired immune system, and consecutive severe infections [22].”

Kimura et al. reported a calculated cut-off value of >702 pg/mL on POD1 linked to four-times-increased rates of subsequent infections in a consecutive, heterogeneous cohort.

“While a calculated cut-off value of >702 pg/mL on POD1 was linked to four-times-increased rates of subsequent infections in a consecutive, heterogeneous cohort by Kimura et al. [22]”