Tumor necrosis factor-alpha, interleukin-6, and nitric oxide in sterile ascitic fluid and serum from patients with cirrhosis who subsequently developascitic fluid infection

Ascitic fluid infection probably results from repeated episodes of bacterem ia and seeding of ascitic fluid. The outcome of these episodes of colonizat ion is probably a function of serum and ascitic fluid defense mechanisms an d the virulence of the organism. Patients who develop spontaneous bacterial peritonitis may have serum and ascitic fluid characteristics that are diff erent from those who do not develop infection. We prospectively collected s erum and ascitic fluid specimens at the time of admission from patients wit h sterile cirrhotic ascites, and tested these specimens for interleukin-6, tumor necrosis factor-alpha, and nitric oxide and compared these results as well as other characteristics of patients who did not develop infection to those who did. An elevated baseline serum tumor necrosis factor-alpha as w ell as an increased proportion of polymorphonuclear leukocytes in sterile a scitic fluid from patients who subsequently developed infection probably re present a subclinical activation of defense mechanisms from prior silent co lonizations with bacteria.