Intervention at the level of the neuroendocrine-immune axis and postoperative pneumonia rate in long-term alcoholics
Department of Medicine, Division of Gastroenterology
APACHE; Aged; Alcoholism; Antifungal Agents; Comorbidity; Cushing Syndrome; Digestive System Neoplasms; Double-Blind Method; Ethanol; Female; Humans; Hydrocortisone; Hypothalamo-Hypophyseal System; Interferon-gamma; Interleukin-10; Ketoconazole; Length of Stay; Male; Middle Aged; Morphine; Pituitary-Adrenal System; Pneumonia; Postoperative Complications; ROC Curve; Stress, Physiological; Th1 Cells; Th2 Cells
Circulatory and Respiratory Physiology | Gastroenterology
RATIONALE: Postoperative pneumonia is three to four times more frequent in patients with alcohol use disorders followed by prolonged intensive care unit (ICU) stay. Long-term alcohol use leads to an altered perioperative hypothalamus-pituitary-adrenal (HPA) axis and immunity.
OBJECTIVES: The aim of this study was to evaluate HPA intervention with low-dose ethanol, morphine, or ketoconazole on the neuroendocrine-immune axis and development of postoperative pneumonia in long-term alcoholic patients.
METHODS: In this randomized, double-blind controlled study, 122 consecutive patients undergoing elective surgery for aerodigestive tract cancer were included. Long-term alcohol use was defined as consuming at least 60 g of ethanol daily and fulfilling the Diagnostic and Statistical Manual of Mental Disorders IV criteria for either alcohol abuse or dependence. Nonalcoholic patients were included but only as a descriptive control. Perioperative intervention with low-dose ethanol (0.5 g/kg body weight per day), morphine (15 mug/kg body weight per hour), ketoconazole (200 mg four times daily), and placebo was started on the morning before surgery and continued for 3 d after surgery. Blood samples to analyze the neuroendocrine-immune axis were obtained on the morning before intervention and on Days 1, 3, and 7 after surgery.
MEASUREMENTS AND MAIN RESULTS: In long-term alcoholic patients, all interventions decreased postoperative hypercortisolism and prevented impairment of the cytotoxic T-lymphocyte type 1:type 2 ratio. All interventions decreased the pneumonia rate from 39% to a median of 5.7% and shortened intensive care unit stay by 9 d (median) compared with the placebo-treated long-term alcoholic patients.
CONCLUSIONS: Intervention at the level of the HPA axis altered the immune response to surgical stress. This resulted in decreased postoperative pneumonia rates and shortened intensive care unit stay in long-term alcoholic patients.
DOI of Published Version
Am J Respir Crit Care Med. 2006 Aug 15;174(4):408-14. Epub 2006 May 25. Link to article on publisher's site
American journal of respiratory and critical care medicine
Spies C, Eggers V, Szabo G, Lau A, von Dossow V, Schoenfeld H, Althoff H, Hegenscheid K, Bohm B, Schroeder T, Pfeiffer S, Ziemer S, Paschen C, Klein M, Marks C, Miller P, Sander M, Wernecke K, Achterberg E, Kaisers U, Volk H. (2006). Intervention at the level of the neuroendocrine-immune axis and postoperative pneumonia rate in long-term alcoholics. Gastroenterology Publications. https://doi.org/10.1164/rccm.200506-907OC. Retrieved from https://escholarship.umassmed.edu/gastroenterology_pp/52