Compartmentalization of the inflammatory response in abdominal sepsis

Introduction

There are three forms of translocation phenomena in sepsis: translocation in a proximal way to the small intestine, in the lymphatic way to peritoneal exudates and lymphatic collectors, and to the portal vein and hepatic circulation. Such factors of sepsis evolution are called decompartmentalization. The aim of our study was to investigate the prognostic value of several biochemical markers in peritoneal exudates in abdominal sepsis.

Methods

One hundred and four patients with general peritonitis and abdominal sepsis were examined. According to the Consensus Conference ACCP/SCCM (1992), the patients were divided intothree groups: the sepsis group (n = 34, the focus of infection and two SIRS symptoms; APACHE II 5 ± 1; SOFA 1.0 ± 0.5); severe sepsis (n = 50, sepsis + multiorgan dysfunction; APACHE II 15 ± 2; SOFA 4.5 ± 2.5); and septic shock (n = 20, severe sepsis + vasopressor agents; APACHE II 25 ± 6; SOFA 7.6 ± 3.5). We researched the markers of SIRS in blood serum and in peritoneal exudates: TNFα (ELISA; DPC Biermann, Bad Nauheim, Germany), IL-1 (ELISA, LIA; Sangtec Medical, Bromma, Sweden), lactoferrine (Vector Best, Russia). The data were analyzed by t test, Fisher criteria. P < 0.05 was considered statistically significant.

Results

The sepsis group was characterized by a brief increase of TNF and IL-1 levels in blood serum on the first day (mean ± SD: TNF, 0.24 ± 0.1 pg/ml vs 0.1 ± 0.06 pg/ml; IL-1, 0.34 ± 0.12 pg/ml vs 0.1 pg/ml, significant). The severe sepsis group was characterized by an increase of TNF and IL-1 levels in blood serum, the considerable increase of TNF level in peritoneal exudates (severe sepsis 0.56 ± 0.21 pg/ml vs sepsis 0.12 ± 0.08 pg/ml, significance), and a significant increase of lactoferrine level in peritoneal exudates. The septic shock group was characterized by the low level of proinflammatory cytokines in blood serum, the increase of the IL-1 level in peritoneal exudates (septic shock 0.78 ± 0.24 pg/ml vs severe shock 0.54 ± 0.25 vs sepsis 0.18 ± 0.09 pg/ml, significant), and the low concentration of lactoferrine in peritoneal exudates.

Conclusion

The nonfavourable outcome in abdominal sepsis was associated with the increase of TNFα and IL-1 levels, and the decrease of the lactoferrine level in peritoneal exudates.