Perioperative TNF alpha and IL-6 concentrations correlate with septic state, organ function, and APACHE II scores in intra-abdominal infection.
OBJECTIVE
To find out if concentrations of tumour necrosis factor a (TNF alpha) and interleukin-6 (IL-6) play a part in the pathophysiology of intra-abdominal infection, and try to identify patients who would benefit from immunotherapy against TNF alpha.


METHODS
Prospective open study.


METHODS
University hospital.


METHODS
19 consecutive patients (septic shock, n = 4; sepsis syndrome, n = 6; and no sepsis syndrome, n = 9, classified by the APACHE II score and the criteria of the Methyl-prednisolone Severe Sepsis Study Group) who were to undergo their first operation for intra-abdominal infection.


METHODS
Correlation between median (interquartile) concentrations of TNF alpha and IL-6 (pg/ml), and APACHE II score, plasma lactate concentration, and organ function.


RESULTS
Perioperative concentrations of both TNF alpha (p = 0.001) and IL-6 (p = 0.006) were significantly higher in patients with septic shock. Preoperative cardiovascular and respiratory failure were associated with significantly raised TNF alpha (p < 0.001 in both cases) and IL-6 concentrations (p = 0.02 and p < 0.001, respectively). The preoperative APACHE II score correlated with the increased TNF alpha concentration (r = 0.5, p < 0.001) and plasma lactate concentration with that of IL-6 (r = 0.7, p = 0.003).


CONCLUSIONS
Perioperative TNF alpha and IL-6 concentrations correlated with the severity of intra-abdominal infection, so it is possible that patients who present with either septic shock or the sepsis syndrome may benefit from immunotherapy against TNF alpha.
Függer
R
R
First Surgical Department and Intensive Care, University of Vienna, School of Medicine, Austria.
Zadrobilek
E
E
Götzinger
P
P
Klimann
S
S
Rogy
M
M
Winkler
S
S
Andel
H
H
Mittelböck
M
M
Roth
E
E
Schulz
F
F
D000005:Abdomen / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000276:immunology* / Q000601:surgery*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D007773:Lactates / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000276:immunology* / Q000601:surgery*; D013577:Syndrome; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
D015850:Interleukin-6; D007773:Lactates; D014409:Tumor Necrosis Factor-alpha