interleukin-8 and Hip-Fractures

To determine whether the plasma concentration of vascular endothelial growth factor (VEGF) is elevated after a common surgical procedure, and if any increase is followed by a reduction in the amount of infused crystalloid fluid in the blood.. Nonrandomized study. Experimental group age-matched to control group.. Operating room of a large medical research center.. 10 ASA physical status I, II, and III patients, aged 51 to 94 years, scheduled for hip surgery; and 10 ASA physical status I and II volunteers, aged 53 to 71 years, comprising a control group.. Patients and control subjects were given an intravenous volume load of Ringer's acetate solution (12.5 mL/kg for 30 min).. The plasma concentrations of C-reactive protein, interleukin-6, interleukin-8 (inflammatory parameters used as biochemical evidence of trauma), and VEGF were measured in patients the morning after the day of the surgery. The area under the curve (AUC) for the plasma dilution was calculated in response to the intravenous fluid.. VEGF concentration was tripled in the hip group (100.7 +/- 18.5 pg/L vs. 31.9 +/- 7.2 pg/L; p < 0.001) as a consequence of the trauma of surgery. The other inflammatory parameters were also significantly increased. There was no difference in AUC between the two groups during infusion, but after infusion AUC was significantly increased in the hip group versus controls (4.88 vs. 2.8; p = 0.025), suggesting persistence of the infused fluid to remain in the vasculature. AUC was not highly correlated with any of the inflammatory parameters regardless of group during or after infusion.. Intravascular persistence of infused crystalloid is increased after hip surgery despite elevated VEGF levels in plasma.

Topics: Aged; Aged, 80 and over; Area Under Curve; C-Reactive Protein; Hip Fractures; Humans; Inflammation; Infusions, Intravenous; Interleukin-6; Interleukin-8; Isotonic Solutions; Middle Aged; Vascular Endothelial Growth Factor A

Delirium is a common and serious complication in geriatric patients. The pathophysiology of delirium is not known.. The objective of the current study was to test the hypothesis that cerebrospinal fluid (CSF) levels of inflammatory markers at the time of spinal anesthesia for hip surgery are associated with delirium.. In total 133 hip fracture patients and 125 cognitively healthy controls undergoing elective surgery, together with 73 Alzheimer's disease (AD) dementia patients, were recruited at Oslo University Hospital and Diakonhjemmet Hospital, Oslo, Norway. Delirium was evaluated daily in hip fracture patients by the Confusion Assessment Method (CAM). Depression was evaluated by Cornell Scale for Depression in Dementia (CSDD). Tumor necrosis factor alpha (TNF-α), interleukin-1beta (IL-1β), and interleukin-8 (IL-8) levels were measured in CSF using a Mesoscale Discovery (MSD) immunoassay.. Hip fracture patients had significantly higher IL-8 levels (p < 0.001) compared to cognitively healthy controls or patients with stable AD dementia. Furthermore, preoperative IL-8 levels were significantly higher (p = 0.013) in hip fracture patients who developed delirium (incident delirium) after surgery as compared to patients with no delirium. However, subgroup analyses showed that IL-8 levels were only significantly higher in delirium patients without dementia (p = 0.006). In contrast, depression subgroup analysis showed that IL-8 concentration was significantly higher (p = 0.002) in delirium patients with depression. Both TNF-α and IL-1β were undetected in most patients.. Our study suggests that IL-8 levels are associated with delirium onset and that underlying depression or dementia influences IL-8 levels.

Topics: Age Factors; Aged; Aged, 80 and over; Alzheimer Disease; Anesthesia; Biomarkers; Delirium; Dementia; Depression; Female; Healthy Volunteers; Hip Fractures; Humans; Inflammation; Interleukin-1beta; Interleukin-8; Male; Mental Status and Dementia Tests; Neuropsychological Tests; Psychiatric Status Rating Scales; Tumor Necrosis Factor-alpha

Fracture of the hip (HF) is a significant cause of morbidity and mortality in elderly individuals. HF is an acute stress that triggers a state of inflammation which may affect immune responses and physical recovery.. Longitudinal study of the impact of HF on the functions of polymorphonuclear neutrophils (PMNs) in elderly subjects. Data were recorded prior to surgery, 6weeks and 6months later.. PMN functions were severely impaired shortly after HF (chemotaxis, phagocytosis, superoxide production) but there was a time-related recovery of some PMN functions (chemotaxis, phagocytosis) over time, except in the case of superoxide production. Whereas FcγRII (CD32) expression remained unchanged, FcγRIII (CD16) increased from low values before surgery to levels of controls 6months post-surgery. This was also the case for the C5a complement receptor and CD11b. TLR2 and TLR4 expressions were unchanged. Cytokine and chemokine secretions by stimulated PMN were altered. TNFα and IL-10 secretions were increased following HF but IL-8 secretion was decreased. Impaired PMN functions prior to surgery were related to alterations in PI3K and NF-κB signaling pathways. Recovery of these functions paralleled increased PI3K activity, although superoxide production remained low. Sustained activation of the NF-κB pathway by TNFα has been reported to involve upregulation of IKKβ kinase activity. Activated IKKβ kinase inhibits ERK1/2 and results in concomitant downstream inhibition of NADPH oxidase complex which can account for sustained impaired production of ROS in HF patients.. Our data showed that the stress caused by HF negatively affects initial PMN responses shortly after the event and that may negatively influence clinical outcomes such as resolving long-term inflammation and recovery, as well as explaining susceptibility to opportunistic infections.

Topics: Aged; Aged, 80 and over; Canada; Case-Control Studies; Chemotaxis; Female; Hip Fractures; Humans; Inflammation; Interleukin-10; Interleukin-8; Male; Neutrophils; Orthopedic Procedures; Perioperative Period; Phagocytosis; Postoperative Complications; Prospective Studies; Receptors, IgG; Recovery of Function; Superoxides; Tumor Necrosis Factor-alpha

Topics: Aged; Aged, 80 and over; Biomarkers; Delirium; Female; Hip Fractures; Humans; Inflammation Mediators; Interleukin-6; Interleukin-8; Male; Middle Aged; Postoperative Complications; Postoperative Period; Reference Values; Tumor Necrosis Factor-alpha

In independent studies delirium was associated with higher levels of cortisol, interleukin(IL)s, and S100B. The aim of this study was to simultaneously compare cortisol, IL-6, IL-8, and S100B levels in patients aged 65years and older admitted for hip fracture surgery with and without delirium. Cortisol, IL-6, IL-8, and S100B were assayed in repeated blood samples. 120 patients (mean age 84years, 62 patients with delirium) were included. Highest levels of IL-8 (27.1, 95% Confidence Interval (CI): 13.6-53.1pg/ml) and cortisol (666, 95% CI: 475-859nmol/L) were before delirium, but of IL-6 (84.3, 95% CI: 46.5-151.4pg/mL) and S100B (0.18, 95% CI: 0.12-0.24 microg/L) during delirium. In multivariable analysis cortisol, LogIL-6, and LogS100B were significantly associated with delirium, but adjusted for pre-existing cognitive impairment, only LogS100B remained significantly associated. Cortisol, IL-6 and S100B may have a role in the pathogenesis of delirium, but S100B is the strongest independent marker.

Topics: Aged; Aged, 80 and over; Biomarkers; Delirium; Female; Hip Fractures; Humans; Hydrocortisone; Immunoassay; Interleukin-6; Interleukin-8; Male; Nerve Growth Factors; S100 Calcium Binding Protein beta Subunit; S100 Proteins

To compare the time-course of cytokine levels in patients with and without delirium and investigate differences in cytokine concentrations in delirium subtypes.. Prospective cohort study.. Academic Medical Center, Amsterdam, 2005 through 2007.. Patients aged 65 and older admitted for surgery after hip fracture.. Experienced geriatric physicians used the Confusion Assessment Method to assess delirium and the Delirium Symptom Interview to assess delirium subtype. Tumor necrosis factor alpha (TNF-alpha) and interleukin (IL)-1beta, IL-6, IL-8, IL-10, and IL-12 were assayed in repeated serum samples using a cytometric bead array immunoassay.. Of 221 admitted patients, 98 (mean age 84, 50 patients with delirium) were included, resulting in a total of 324 samples. Ninety-six percent of these samples had TNF-alpha, IL-1beta, and IL-10 levels below the reliable detection level. Differences between patients with and without delirium were observed in IL-6 (median 51 vs 36 pg/mL, P=.01) and IL-8 (median 15 vs 9 pg/mL, P=.03) levels. Changes over time in IL-6 and IL-8 levels in patients with delirium differed significantly from changes in levels in patients without delirium. The highest levels of IL-6 were present during delirium, and the highest levels of IL-8 were present before the development of delirium. Patients with the hyperactive (median 71 pg/mL) or mixed (median 73 pg/mL) subtype of delirium had higher IL-6 levels than patients with hypoactive delirium (median 16 pg/mL) (P=.02).. IL-6 and IL-8 may contribute to the pathogenesis of postoperative delirium in elderly people. IL-6 may play a role in the hyperactive behavior of delirium.

Topics: Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Cohort Studies; Cytokines; Delirium; Female; Femoral Neck Fractures; Fracture Fixation, Internal; Hip Fractures; Humans; Interleukin-6; Interleukin-8; Male; Netherlands; Patient Admission; Postoperative Complications; Prospective Studies; Psychomotor Agitation; Statistics as Topic; Time Factors

The study aim was to determine the kinetics of serum pro- and anti-inflammatory cytokines and C-reactive protein (CRP) in hip-fracture patients over a month postfracture, and their relationship to postoperative (postop) complications and cognitive level.. Forty-one elderly hip-fracture patients were prospectively followed. Serum was obtained during the first 10 hours postfracture and presurgery, 48-60 hours postop, 7 and 30 days postop, measuring CRP, interleukin-1beta (IL-1beta), IL-6, IL-8, tumor necrosis factor-alpha (TNF-alpha), IL-10, and IL-1 receptor antagonist (IL-1RA).. A significant increase was found postop for CRP, IL-6, TNF-alpha, IL-1RA (p <.001), IL-10 (p <.002), and IL-8 (p =.05). CRP kinetics curves were higher in patients with complications as a group, and in those suffering from infections, delirium, and cardiovascular complications (p <.05). IL-6 increase in patients with complications approached significance. Additional complications appeared in patients with impaired mental status (IMS) versus cognitively normal patients (p =.037). Higher kinetics curves in the IMS patients were found for CRP and IL-6 (p <.05). Analyzing the interaction effect of complications and IMS on CRP and cytokines production demonstrated that the increase in CRP was independently related to complications and IMS. IL-6, IL-8, and IL-10 were higher in IMS patients but not in patients with complications without IMS (p <.05).. Serum CRP and cytokines increased drastically in postop hip-fracture elderly patients. Only CRP significantly and independently increased in IMS patients and in patients with complications, whereas cytokines significantly increased only in IMS patients. This study raises questions about possible effects that cytokine generation, after hip-fracture repair, might have on cognition and complications.

Topics: Aged; Aged, 80 and over; C-Reactive Protein; Cytokines; Female; Hip Fractures; Humans; Inflammation Mediators; Interleukin-10; Interleukin-6; Interleukin-8; Kinetics; Male; Mental Health; Postoperative Complications; Postoperative Period; Prospective Studies; Time Factors