Elevated levels of soluble tumor necrosis factor receptors are associated with increased mortality rates in patients who undergo operation for ruptured abdominal aortic aneurysm

Purpose: Elevated levels of soluble tumor necrosis factor receptors (sTNF-R s) are associated with multiple organ failure and increased mortality rates in critically ill patients. Paradoxically, experimental data suggest exoge nous sTNF-Rs may improve outcome in patients who undergo elective abdominal aortic aneurysm (AAA) repair, This study examines, for the first time, cha nges in sTNF-R levels during repair of ruptured and nonruptured AAA. Methods: Sixteen patients who underwent surgical procedures for ruptured AA A and 10 patients who underwent surgical procedures for nonruptured AAA wer e studied, Levels of sTNF-Rs p55 and p75 were measured before the operation and immediately before and 5 minutes, 6 hours, and 24 hours after aortic c lamp release, Results: When compared with nonruptured AAA, levels of sTNF-R p55 were sign ificantly higher in ruptured AAA 5 minutes (P < .02) and 24 hours after aor tic clamp release (P < .05). Levels of sTNF-R p75 were significantly higher in ruptured AAA before (P < .05), during (P < .001), and after the surgica l procedure (P < .01), Six hours after aortic clamp release, sTNF-R p75 lev els were. significantly higher in nonsurvivors of ruptured AAA when compare d with survivors (P < .05) and patients whet underwent: surgical procedures for nonruptured AAA. (P < .01). Conclusion: Ruptured AAA repair is associated with increased sTNF-R express ion, Furthermore, elevated levels of sTNF-R p75 are associated with increas ed postoperative mortality rates.