Coagulation and cytokine profile after major hepatobiliary surgery in Chinese patients

Abstract

Background/Aims: Hypercoagulability and increased circulating cytokine levels have been separately reported after surgical operations. We investigated whether the cytokine level and post-operative coagulation profile would change similarly in Chinese patients undergoing major hepatobiliary surgery. Methodology: Serial serum levels of IL-6 IL-1β and TNF-α were measured by colorimetric ELISA. Serial coagulation profile was measured by thrombelastography. Hemoglobin and white cell counts were also measured serially. Results: Only mild hypercoagulability was found at the 12th and 144th hours, evidenced by shortening of r-time and k-time on thrombelastography (P<0.05). IL-6 and IL-1β levels were significantly raised from the 12th hour (P<0.01) while TNF-α level was unchanged. From the 3rd hour to the 48th hour, there was negative correlation between IL-6 levels and various thrombelastographic parameters such as coagulation index (r=-0.777, P<0.001); k-time (r=0.478, P<0.05); maximum amplitude (r=-0.688, P<0.01) and angle (r=-0.665, P<0.01). Conclusions: We observed a much milder degree of hypercoagulability in Chinese patients after major hepatobiliary surgery as compared to those reported in other operations in non-Chinese patients. Unlike in sepsis where a close link between increased cytokine levels and hypercoagulability has been reported, increase in IL-6 was associated with less hypercoagulability in Chinese patients after major hepatobiliary surgery.