{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T08:25:41Z","timestamp":1775031941745,"version":"3.50.1"},"reference-count":55,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2006,8,1]],"date-time":"2006-08-01T00:00:00Z","timestamp":1154390400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2006,8,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>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\u2013pituitary\u2013adrenal (HPA) axis and immunity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The aim of this study was to evaluate HPA intervention with low-dose ethanol, morphine, or ketoconazole on the neuroendocrine\u2013immune axis and development of postoperative pneumonia in long-term alcoholic patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 \u03bcg\/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\u2013immune axis were obtained on the morning before intervention and on Days 1, 3, and 7 after surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.200506-907oc","type":"journal-article","created":{"date-parts":[[2006,5,25]],"date-time":"2006-05-25T21:06:04Z","timestamp":1148591164000},"page":"408-414","source":"Crossref","is-referenced-by-count":66,"title":["Intervention at the Level of the Neuroendocrine\u2013Immune Axis and Postoperative Pneumonia Rate in Long-term Alcoholics"],"prefix":"10.1093","volume":"174","author":[{"given":"Claudia","family":"Spies","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, Institute of Laboratory Medicine and Pathobiochemistry, and Institute of Medical Biometry, Campus Charit\u00e9 Mitte and Campus Virchow Klinikum; Institute of Medical Immunology, Campus Charit\u00e9 Mitte; Department of Otorhinolaryngology and Head and Neck Surgery, Campus Charit\u00e9 Mitte, Campus Virchow Klinikum, and Campus Benjamin Franklin; Clinic and Polyclinic for Oral and Maxillofacial Surgery and Plastic Surgery, Campus Virchow Klinikum; and Department of Maxillofacial and Plastic Surgery, Campus Benjamin Franklin, Charit\u00e9\u2013University Medicine Berlin, Berlin, Germany; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; and Center for Drug and Alcohol Programs, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Verena","family":"Eggers","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, Institute of Laboratory Medicine and Pathobiochemistry, and Institute of Medical Biometry, Campus Charit\u00e9 Mitte and Campus Virchow Klinikum; Institute of Medical Immunology, Campus Charit\u00e9 Mitte; Department of Otorhinolaryngology and Head and Neck Surgery, Campus Charit\u00e9 Mitte, Campus Virchow Klinikum, and Campus Benjamin Franklin; Clinic and Polyclinic for Oral and Maxillofacial Surgery and Plastic Surgery, Campus Virchow Klinikum; and Department of Maxillofacial and Plastic Surgery, Campus Benjamin Franklin, Charit\u00e9\u2013University Medicine Berlin, Berlin, Germany; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; and Center for Drug and Alcohol Programs, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gyongyi","family":"Szabo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, Institute of Laboratory Medicine and Pathobiochemistry, and Institute of Medical Biometry, Campus Charit\u00e9 Mitte and Campus Virchow Klinikum; Institute of Medical Immunology, Campus Charit\u00e9 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