Purpose Intra-abdominal infection is considered the second most common cause of sepsis and results in localized or diffused inflammation of the peritoneum. The main treatment for abdominal sepsis is an emergency laparotomy for source control. However, surgical trauma also causes inflammation, and patients become susceptible to postoperative complications. Therefore, it is necessary to identify biomarkers that can be used to distinguish sepsis from abdominal infection. This prospective study investigated whether cytokine levels in the peritoneum could predict complications and indicate severity of sepsis following emergency laparotomy. Methods We prospectively observed 97 patients with abdominal infection admitted to the Intensive Care Unit (ICU). After emergency laparotomy,SEPSIS-3 criteria were used for the diagnosis of sepsis or septic shock. Blood and peritoneal fluid samples were drawn at postoperative admission to the ICU and cytokine concentrations were measured by flow cytometry. Results Fifty-eight postoperative patients were enrolled. We found significant elevations in the peritoneal concentrations of IL-1β, IL-6, TNF-α, IL-17, and IL-2 in patients with sepsis or septic shock compared to the patients without sepsis after surgery. Positive correlations between levels of these peritoneal cytokines with APACHE II scores were found: IL-6, in particular, had the highest correlation coefficient of 0.833. Meanwhile, IL-10 in blood, MCP-1 and IL-8 in both blood and peritoneum were simultaneously increased in patients with sepsis and septic shock, and also positively correlated with disease severity. Conclusion The cytokine storm that occurs in the abdominal cavity after emergency laparotomy may be the main mechanism leading to sepsis. It may be valuable to measure IL-1β, IL-6, TNF-α,IL-17, IL-2, MCP-1, and IL-8 in the peritoneal fluid, combined with serum IL-10, MCP-1 and IL-8, in a panel of cytokines, to assess the severity of sepsis and predict mortality from abdominal infection after emergency laparotomy.
Background: An intra-abdominal infection is regarded as the second most course of sepsis, and results in either localized or diffused inflammation of the peritoneum. The main treatment of abdominal sepsis is emergency laparotomy for source control. However, surgical trauma also causes inflammation and patients may become susceptible to postoperative complications. Therefore, it is necessary to identify biomarkers that can be used to distinguish sepsis from abdominal infection. Herein, the aim of this study was to investigate whether cytokines in abdominal cavity predict septic complications and their ability to indicate severity of illness following emergency laparotomy. Methods: We prospectively observed fifty-eighty patients with abdominal infection admitted to the intensive care unit (ICU) after emergency open abdominal surgery. SEPSIS-3 criteria were used for the diagnosis of sepsis or septic shock group. Blood samples and peritoneal fluid were drawn within eight hours of admission after surgery, clinical data were collected. Concentrations of cytokines both from serum and abdominal cavity were measured by using the LEGENDplexTM ®technique based on the flow cytometer. Results: We found significant elevations in peritoneal concentrations of IL-1β, IL-6, TNF-α,IL-17 ,IL-2 in the sepsis or septic shock patients compared with non-sepsis group after surgery. Positive correlations between these peritoneal cytokines with APACHE II scores, especially IL-6 had the highest correlation coefficient of 0.833. At meantime, IL-10 in the blood, chemokines of MCP-1 and IL-8 both in blood and peritoneum were extremely high in abdominal sepsis and septic shock patients, and also positive correlated with disease severity. Conclusions: This study suggests that cytokine storm occurred in abdominal cavity after emergency laparotomy which may be a main mechanism leading to sepsis. It may be useful to conduct IL-1β, IL-6, TNF-α,IL-17 ,IL-2 ,MCP-1 and IL-8 from the peritoneal fluid, combined with serum IL-10, MCP-1 and IL-8, into a cytokine panel, which may be valuable for assessing severity of sepsis and predicting mortality for abdominal infection after emergency laparotomy.
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