Open Access Open Badges Research

Changes in serum and cerebrospinal fluid cytokines in response to non-neurological surgery: an observational study

Sara Bromander135*, Rolf Anckarsäter12, Marianne Kristiansson3, Kaj Blennow1, Henrik Zetterberg1, Henrik Anckarsäter1 and Caroline E Wass14

Author Affiliations

1 Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden

2 Department of Anesthesiology and Intensive Care, Kungälv Hospital, Stockholm, Sweden

3 Department of Clinical Neuroscience, Division of Forensic Psychiatry, Karolinska Institutet, Stockholm, Sweden

4 Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto and the Schizophrenia Program, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada

5 Institute of Neuroscience and Physiology, Department of Forensic Psychiatry, Gothenburg University, Sahlgrenska Academy, Wallinsgatan 8, 43141, Mölndal, Sweden

For all author emails, please log on.

Journal of Neuroinflammation 2012, 9:242  doi:10.1186/1742-2094-9-242

Published: 24 October 2012



Surgery launches an inflammatory reaction in the body, as seen through increased peripheral levels of cytokines and cortisol. However, less is known about perioperative inflammatory changes in the central nervous system (CNS).

Our aim was to compare inflammatory markers in serum and cerebrospinal fluid (CSF) before and after surgery and evaluate their association with measures of blood–brain barrier (BBB) integrity.


Thirty-five patients undergoing knee arthroplastic surgery with spinal anesthesia had CSF and serum samples drawn before, after and on the morning following surgery. Cytokines and albumin in serum and CSF and cortisol in CSF were assessed at all three points.


Cytokines and cortisol were significantly increased in serum and CSF after surgery (Ps <0.01) and CSF increases were greater than in serum. Ten individuals had an increased cytokine response and significantly higher CSF/serum albumin ratios (Ps <0.01), five of whom had albumin ratios in the pathological range (>11.8). Serum and CSF levels of cytokines were unrelated, but there were strong correlations between CSF IL-2, IL-10 and IL-13, and albumin ratios (Ps <0.05) following surgery.


Cytokine increases in the CNS were substantially greater than in serum, indicating that the CNS inflammatory system is activated during peripheral surgery and may be regulated separately from that in the peripheral body. CSF cytokine increase may indicate sensitivity to trauma and is linked to BBB macromolecular permeability.

Cytokine; Blood–brain barrier; Central nervous system; Arthroplastic surgery; Cortisol; Albumin; Interleukin; Inflammation