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Mediators of Inflammation
Volume 2014 (2014), Article ID 727451, 8 pages
Research Article

Cardiopulmonary Exercise Capacity and Preoperative Markers of Inflammation

1Clinical Physiology, Division of Medicine, University College London, London WC1E 6BT, UK
2Department of Anaesthesia, Derriford Hospital and Peninsula Medical School, Plymouth PL6 8DH, UK

Received 11 April 2014; Revised 10 June 2014; Accepted 11 June 2014; Published 26 June 2014

Academic Editor: Jonathan Peake

Copyright © 2014 Pervez Sultan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Explanatory mechanisms for the association between poor exercise capacity and infections following surgery are underexplored. We hypothesized that aerobic fitness—assessed by cardiopulmonary exercise testing (CPET)—would be associated with circulating inflammatory markers, as quantified by the neutrophil-lymphocyte ratio (NLR) and monocyte subsets. The association between cardiopulmonary reserve and inflammation was tested by multivariable regression analysis with covariates including anaerobic threshold (AT) and malignancy. In a first cohort of 240 colorectal patients, AT was identified as the sole factor associated with higher NLR and absolute and relative lymphopenia . Preoperative leukocyte subsets and monocyte CD14+ expression (downregulated by endotoxin and indicative of chronic inflammation) were also assessed in two further cohorts of age-matched elective gastrointestinal and orthopaedic surgical patients. Monocyte CD14+ expression was lower in gastrointestinal patients compared to age-matched orthopaedic patients . The circulating CD14+CD16 monocyte subset was reduced in patients with low cardiopulmonary reserve. Poor exercise capacity in patients without a diagnosis of heart failure is independently associated with markers of inflammation. These observations suggest that preoperative inflammation associated with impaired cardiorespiratory performance may contribute to the pathophysiology of postoperative outcome.