INFLAMMATORY RESPONSE IN PERITONEAL-EXUDATE AND PLASMA OF PATIENTS UNDERGOING PLANNED RELAPAROTOMY FOR SEVERE SECONDARY PERITONITIS

Objective: To study the pattern of intraperitoneal cytokine release in secondary peritonitis and its correlation with plasma levels and prog nosis. Design: Noncomparative descriptive case series. Setting: Depart ment of surgery in a university hospital. Patients: Seventeen consecut ive patients undergoing planned relaparotomy for severe intra-abdomina l infection (Acute Physiological and Chronic Health Evaluation [APACHE II] score >10; mean score, 17.5). Interventions: The following were m easured at the first and last serial operations in the peritoneal exud ate and plasma: endotoxin, tumor necrosis factor alpha (TNF-alpha), in terleukin-1 (IL-1), interleukin-6 (IL-6), elastase, and neopterin. Mai n Outcome Measures: Survival and death. Results: Six patients died. Pe ritoneal endotoxin levels were significantly higher than in the plasma and were significantly higher in the nonsurvivors. Plasma TNF-alpha, IL-6, elastase, and neopterin levels remained elevated in the nonsurvi vors prior to death. Levels of TNF-alpha, IL-6, elastase, and endotoxi n were 19, 993, 239, and 7 times higher, respectively, in the peritone al exudate than in plasma, all significant differences. Elastase and T NF-alpha levels decreased in survivors during the operative treatment but remained elevated in the nonsurvivors. Conclusions: Secondary peri tonitis is associated with a significant cytokine-mediated inflammator y response that is compartmentalized in the peritoneal cavity and indi cates an adverse prognosis. Levels of cytokines in the exudate of peri tonitis may be used to better stratify the severity of peritonitis and , in future, to guide local therapy.