PERIOPERATIVE TNF-ALPHA AND IL-6 CONCENTRATIONS CORRELATE WITH SEPTICSTATE, ORGAN FUNCTION, AND APACHE-II SCORES IN INTRAABDOMINAL INFECTION

Objective: To find out if concentrations of tumour necrosis factor a ( TNF alpha) and interleukin-6 (IL-6) play a part in the pathophysiology of intra-abdominal infection, and try to identify patients who would benefit from immunotherapy against TNF alpha. Design: Prospective open study. Setting: University hospital. Subjects: 19 consecutive patient s (septic shock, n = 4; sepsis syndrome, n = 6; and no sepsis syndrome , n = 9, classified by the APACHE II score and the criteria of the Met hylprednisolone Severe Sepsis Study Group) who were to undergo their f irst operation for intra-abdominal infection. Main outcome measures: C orrelation between median (interquartile) concentrations of TNF alpha and IL-6 (pg/ml), and APACHE II score, plasma lactate concentration, a nd organ function. Results: Perioperative concentrations of both TNF a lpha (p = 0.001) and IL-6 (p = 0.006) were significantly higher in pat ients with septic shock. Preoperative cardiovascular and respiratory f ailure were associated with significantly raised TNF alpha (p < 0.001 in both cases) and IL-6 concentrations (p = 0.02 and p < 0.001, respec tively). The preoperative APACHE II score correlated with the increase d TNF alpha concentration (r = 0.5, p < 0.001) and plasma lactate conc entration with that of IL-6 (r = 0.7, p = 0.003). Conclusion: Perioper ative TNF alpha and IL-6 concentrations correlated with the severity o f intra-abdominal infection, so it is possible that patients who prese nt with either septic shock or the sepsis syndrome may benefit from im munotherapy against TNF alpha.