Therapy of compartmentalization of the proinflammatory and anti-inflammatory cytokines in sepsis

Introduction

We supposed the diagnostic significance of the ratio between proinflammatory and anti-inflammatory cytokines in the peritoneal cavity and system blood flow in patients with abdominal sepsis. So we tried to correct such disbalance with glutamine intravenous and enteral supplementation.

Methods

Prospective controlled randomized investigation of the patients with abdominal sepsis (excluding pancreatitis). Group 1 (n = 16): standard therapy. Group 2 (n = 11): with intravenous infusion of glutamine (Dipeptiven; Fresenius Kabi, Germany). Group 3 (n = 11): with intravenous infusion of glutamine and enteral supplementation of glutamine (Intestamine; Fresenius Kabi). The patients in groups were identical according to the severity of disease (APACHE II), the standard of intensive care, the volume of surgery care. We investigated the proinflammatory cytokines: TNFα, IL-1, IL-6, IL-8; and anti-inflammatory cytokines: soluble sTNF-RI and sTNF-RII, antagonist receptor IL-1, IL-10 in blood serum and in the peritoneal cavity during the initial 3 days of intensive care (ELISA; BD Biosciences Pharmingen, San Diego, CA, USA; EASIAs; Biosource, Nivelles, Belgium).

Results

The probability of survival on day 28 was 73% in the standard therapy group, in the group with glutamine intravenous - 78%, in the group with glutamine intravenous and enteral - 84%. We did not fix the decrease of the duration of respiratory support in all of the groups. The duration of acute intestinal injury was significantly different (standard group 49 hours vs 38 hours in group with glutamine intravenous supplementation - 35 hours in group with intravenous and enteral glutamine supplementation). We investigated the prevalence of the concentration of proinflammatory cytokines in the peritoneal cavity and in blood serum according to the molar coefficient in the control group. The molar coefficient had a positive correlation with the SOFA scale. In group 2 (glutamine intravenous) the molar coefficients were decreased to the prevalence of anti-inflammatory cytokines (in serum on day 3, in peritoneal on day 2). In group 3 (glutamine intravenous and enteral) we investigated the significance difference and decrease of all cytokine levels in blood serum and in the peritoneal cavity.

Conclusions

Intravenous and enteral supplementation of glutamine improved the cytokine balance in blood and the peritoneal compartment.