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Inflammatory cytokine response in patients with septic shock secondary to generalized peritonitis

Riché, Florence C. MD; Cholley, Bernard P. MD, PhD; Panis, Yves H. MD, PhD; Laisné, Marie-Josèphe C. MD; Briard, Claudette G. MD; Graulet, Anne-Marie MS; Guéris, Jean L. MD; Valleur, Patrice D. MD

Clinical Investigations
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Objectives: The aims of this study were the following: a) to assess the proinflammatory cytokine (tumor necrosis factor [TNF]-α, interleukin [IL]-1, and IL-6) response in patients with septic shock secondary to generalized peritonitis; and b) to evaluate the influence of bacteremic status, type of peritonitis (acute perforation or postoperative), and peritoneal microbial status (mono- or polymicrobial) on cytokine expression and mortality.

Design: Prospective study.

Setting: Surgical intensive care unit of a university hospital.

Patients: Fifty-two consecutive patients with septic shock caused by generalized peritonitis.

Interventions: Routine blood tests, blood cultures, and cytokine assays were performed during the first 3 days after onset of shock.

Measurements and Main Results: Serum TNF-α and IL-6 concentrations were measured by using a radioimmunoassay, and IL-1 concentrations were measured by using ELISA. Median serum concentrations on day 1 were: TNF-α, 90 pg/mL; IL-1, 7 pg/mL; and IL-6, 5000 pg/mL. TNF-α and IL-6 concentrations decreased significantly between the first and third days of septic shock (p= .0001), whereas IL-1 concentrations remained low. The decrease in IL-6 tended to be more pronounced in the survivors group (p= .057). Median TNF-α serum concentrations were higher in bacteremic compared with nonbacteremic patients (151 vs. 73 pg/mL,p= .003). TNF-α, IL-1, and IL-6 serum concentrations and mortality were not different between acute perforation vs. postoperative peritonitis and mono- versus polymicrobial peritonitis.

Conclusions: The systemic release of TNF-α and IL-6 during septic shock caused by generalized peritonitis was maximal on day 1 and decreased rapidly during the next days. No systemic release of IL-1 was observed. IL-6 serum concentrations remained higher in patients who subsequently died. Among the different features of peritonitis studied, only bacteremia influenced the systemic cytokine response (higher TNF-α).

From the Departments of Anesthesiology (Drs. Riché, Cholley, Laisné, and Briard), Surgery (Drs. Panis and Valleur), and Radio-Immunology (Drs. Graulet and Guéris), Hôpital Lariboisière, Paris, France.

Supported, in part, by Assistance Publique-Hôpitaux de Paris.

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