INCREASED CONCENTRATIONS OF CYTOKINES AND ADHESION MOLECULES IN PATIENTS AFTER REPAIR OF ABDOMINAL AORTIC-ANEURYSM

Objective: To evaluate the association between inflammatory mediators and clinical outcome in patients after repair of abdominal aortic aneu rysms. Design: Prospective study. Setting: University hospital, The Ne therlands. Patients: 30 Consecutive patients who had undergone electiv e or acute repair of abdominal aortic aneurysms. Main outcome measures : Plasma concentrations of the cytokines tumour necrosis factor (TNF), interleukin-6 (IL-6) and interleukin-8 (IL-8) as well as soluble TNF receptors and the soluble (s) adhesion molecules E-selectin and interc ellular adhesion molecule 1 (ICAM-1) were measured and correlated with the degree of systemic hypotension (shock: hypotension more than 15 m inutes) and clinical outcome. Results: Peak plasma concentrations of T NF and IL-6 were significantly higher in shocked patients (p < 0.005 a nd p < 0.0005, respectively) and those who died (both p < 0.01), where as concentrations of IL-8 increased only when shock complicated ruptur e of the aneurysm (p < 0.01). Increases in the concentrations of TNF r eceptors reflected impaired renal function. In contrast to sE-selectin concentrations, peak sICAM-1 concentrations were significantly higher in shocked patients (p < 0.01) and those that died (p < 0.01). Conclu sions: These results strongly suggest that increased concentrations of sICAM-1 and IL-6 reflect the inflammatory response induced by ischaem ia after repair of an abdominal aortic aneurysm, and indicate that the postoperative course is likely to be complicated.