PERIOPERATIVE PLASMA-CONCENTRATIONS OF TUMOR-NECROSIS-FACTOR-ALPHA AND INTERLEUKIN-6 IN INFECTED PATIENTS

Objective: To characterize the sequential plasma concentrations of tum or necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) and thei r relationship with the clinical outcome in patients with intra abdomi nal infection who underwent surgical intervention. Design: A prospecti ve, comparative study. Setting: Surgical intensive care unit of a univ ersity hospital. Patients: Fifteen patients with surgically proved int ra-abdominal infection were included as the infected group, The compar ative noninfected group consisted of ten patients who underwent major abdominal surgery without infection. Interventions: Blood samples were obtained from the indwelling arterial catheter before induction of ge neral anesthesia, and 1, 1.5, 2, 3, 4, 6, and 24 hrs after skin incisi on. Measurements and Main Results: Plasma cytokine concentrations were measured using radioimmunoassay, The hemodynamic and physiologic para meters were recorded for comparison with cytokine concentrations, In t he noninfected group, the TNF-alpha concentration was very low through out the observation period, and the IL-6 concentration increased 4 hrs after skin incision, The infected group had significantly higher TNF- alpha and IL-6 concentrations than the noninfected group, The TNF-alph a concentration in creased from 129.2 +/- 46.4 to 1196.0 +/- 445.8 pg/ mL and the IL-6 concentration increased from 54.2 +/- 24.3 to 560.3 +/ - 187.5 pg/mL 2 hrs after skin incision in the infected group, The pos toperative APACHE II score correlated significantly with both peak IL- 6 (r(2) = .39) and peak TNF-alpha (r(2) = .32) concentrations. Conclus ions: Both TNF-alpha and IL-6 concentrations increased significantly a fter surgical intervention in patients with intraabdominal infection, The pulse increase in TNF-alpha concentration and the persistent incre ase in IL-6 concentration were related to the poor postoperative clini cal condition in infected patients.