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Original Research: CHEST INFECTIONS |

Hospital-Acquired Pneumonia After Lung Resection Surgery Is Associated With Characteristic Cytokine Gene Expression

Mary White, MB; Ignacio Martin-Loeches, PhD; Matthew W. Lawless, PhD; Michael J. O’Dwyer, PhD; Derek G. Doherty, PhD; Vincent Young, MB; Dermot Kelleher, MD; Ross McManus, PhD; Thomas Ryan, MB
Author and Funding Information

From the Department of Anaesthesia and Intensive Care Medicine (Drs White, Martin-Loeches, O’Dwyer, and Ryan), and the Department of Cardiothoracic Surgery (Dr Young), St James Hospital, Dublin, Ireland; Department of Clinical Medicine (Drs White, Lawless, Kelleher, and McManus), and the Department of Immunology (Dr Doherty), Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland; and the Critical Care Department (Dr Martin-Loeches), Joan XXIII University Hospital, University Rovira i Virgili, IISPV, CIBER Enfermedades Respiratorias (CIBERes) Tarragona, Spain.

Correspondence to: Mary White, MB, Department of Anaesthesia and Critical Care Medicine, St. James Hospital, Dublin 8, Ireland; e-mail: drmbwhite@yahoo.co.uk


Funding/Support: This study was funded by the Royal City of Dublin Hospital Trust Fund and the Association of Anaesthetists of Great Britain and Ireland.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(3):626-632. doi:10.1378/chest.10-0016
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Background:  Infection in humans has been linked with altered cytokine gene transcription. It is unclear whether this phenomenon is a consequence of an established disease process or precedes the infective process. The primary end point of this study was to determine whether hospital-acquired pneumonia (HAP) was associated with differential gene expression of interferon (IFN)-γ, tumor necrosis factor (TNF)-α, and IL-23p19. The secondary end point was to identify whether alteration in gene expression preceded the clinical onset of infection.

Methods:  Sixty consecutive patients undergoing elective thoracic surgery were recruited. HAP was diagnosed as per National Nosocomial Infection Surveillance guidelines. Messenger RNA (mRNA) and protein levels were analyzed preoperatively and 24 h and 5 days postoperatively.

Results:  Forty-one patients had an uncomplicated recovery. Nineteen patients developed HAP. IL-6, IL-10, IL-12p35, IL-23p19, IL-27p28, TNF-α, and IFN-γ mRNA and protein levels of IL-6, IL-23, and IFN-γ in peripheral blood leukocytes were analyzed before surgery and 24 h and 5 days postsurgery. IL-23p19 mRNA levels were reduced in the pneumonia group (median, 4.19; 10th-90th centile range, 3.90-4.71) compared with the nonpneumonia group (4.50; 3.85-5.32) day 1 postsurgery (P =.02). IFN-γ mRNA levels were reduced in the pneumonia group (2.48; 1.20-3.20) compared with nonpneumonia group (2.81; 2.10-3.26) (P =.03) day 5 postsurgery. Results are expressed as log to base 10 copy numbers of cytokine mRNA per 10 million β-actin mRNA copy numbers. All values are given as median and 10th to 90th centile range.

Conclusions:  Cytokine gene expression is altered immediately following surgery in patients with postoperative HAP.


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