The value of immune modulating parameters in predicting the progression from peritonitis to septic shock

Intra-abdominal infection is one of the major causes of septic shock and mu ltiple organ failure. To date, what causes the disease's progression remain s unclear and therefore the relevance of immune modulating therapies remain s speculative. The primary outcome measure of this study was to investigate immune modulating mediators at the onset of peritonitis before the develop ment of subsequent septic shock. The secondary outcome measure was to inves tigate the usefulness of these immune parameters in predicting progression from peritonitis to septic shock. Fifty-eight peritonitis patients were inc luded in this study: 14 patients subsequently developed septic shock. All p atients were examined on "diagnosis of peritonitis" (<4 h within establishm ent of diagnosis), during "early septic shock" (<12 h following the onset o f septic shock), and once again during "late septic shock" ( within 72-98 h following the onset of septic shock). The immune modulating parameters tum or necrosis factor-alpha (TNF-alpha), the soluble TNF-alpha receptors I and II (sTNF-alpha RI and sTNF-alpha RII), interleukines (IL) -1 beta, -6, -8, and -10, and the adhesions molecules endothelial-leukocyte-adhesion-molecu le (E-Selectin), intercellular-adhesion-molecule-1(ICAM-1) and vascular-adh esion-molecule-1 (VCAM-1), in addition to nitrate and nitrite, were determi ned. In the peritonitis group with subsequent septic shock, TNF-alpha, sTNF -alpha RI + RII IL-l beta, IL-8, IL-10, and nitrate were significantly incr eased before the onset of septic shock. TNF-alpha had an area under the rec eiver operating characteristics curve (AUC) of 0.84 and was reliable in pre dicting the progression from peritonitis to septic shock. The AUC of the ot her immune modulating parameters, despite being significantly elevated, ran ged from 0.71 to 0.76. The AUC of the conventional laboratory markers such as leukocytes and C-reactive protein ranged from 0.64 to 0.68, In peritonit is that progressed to septic shock, an early immune response had already oc curred before the onset of septic shock. The progression was best predicted by TNF-alpha. Therefore, mediator therapy might be considered in high-risk peritonitis patients who show an exaggerated immune response before the pr ogression to septic shock.