SERUM LEVELS OF INTERLEUKIN-1 AND TUMOR-NECROSIS-FACTOR A CORRELATE WITH PERITONEAL ADHESION GRADES IN HUMANS AFTER MAJOR ABDOMINAL-SURGERY

Peritoneal adhesions are a leading cause of potential morbidity and mo rtality. We undertook this prospective study to determine the clinical relevance of interleukin 1 (IL-1) and tumor necrosis factor alpha (TN F-alpha) levels as biological markers for peritoneal adhesion formatio n in humans. Fifteen patients who had previous colectomies and were un dergoing re-exploration for an elective vascular procedure were studie d. Blood samples were collected from each patient preoperatively and 3 0 minutes after the abdominal incision was made. Serum levels of IL-1 and TNF-alpha were determined using enzyme-linked immunosorbent assay kits. Adhesions were graded using an adhesion scale of 0 (none), 1 (mi ld), 2 (moderate), and 3 (extensive, dense). Preoperative levels of IL -1 and TNF-alpha did not differ significantly among all patients (IL-1 level was 60 +/- 14 pg/mL, and TNF-alpha level was 45 +/- 11 pg/mL; m ean +/- standard deviation). Significant correlation was observed betw een grades of adhesions and early intraoperative levels of IL-1 [101 /- 36 pg/mL for grade 1 (n = 8) vs 298 +/- 73 pg/mL for grade 3 (n = 6 ); P < 0.01] and TNF-alpha (88 +/- 23 pg/mL for grade 1 vs 261 +/- 88 mt for grade 3; P < 0.02). We conclude that early elevations of IL-1 a nd TNF-alpha are reliable biological markers for postoperative adhesio ns in humans. Studies utilizing cytokines antibodies to these markers may further elucidate the efficacy of this method for prevention of pe ritoneal adhesions.