Elevated levels of soluble tumor necrosis factor receptors are associated with increased mortality rates in patients who undergo operation for ruptured abdominal aortic aneurysm.
OBJECTIVE
Elevated levels of soluble tumor necrosis factor receptors (sTNF-Rs) are associated with multiple organ failure and increased mortality rates in critically ill patients. Paradoxically, experimental data suggest exogenous sTNF-Rs may improve outcome in patients who undergo elective abdominal aortic aneurysm (AAA) repair. This study examines, for the first time, changes in sTNF-R levels during repair of ruptured and nonruptured AAA.


METHODS
Sixteen patients who underwent surgical procedures for ruptured AAA and 10 patients who underwent surgical procedures for nonruptured AAA were 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 clamp release.


RESULTS
When compared with nonruptured AAA, levels of sTNF-R p55 were significantly higher in ruptured AAA 5 minutes (P <.02) and 24 hours after aortic clamp release (P <.05). Levels of sTNF-R p75 were significantly higher in ruptured AAA before (P <.05), during (P <.001), and after the surgical procedure (P <.01). Six hours after aortic clamp release, sTNF-R p75 levels were significantly higher in nonsurvivors of ruptured AAA when compared with survivors (P <.05) and patients who underwent surgical procedures for nonruptured AAA (P <.01).


CONCLUSIONS
Ruptured AAA repair is associated with increased sTNF-R expression. Furthermore, elevated levels of sTNF-R p75 are associated with increased postoperative mortality rates.
Adam
D J
DJ
Vascular Surgery Unit, University Department of Clinical and Surgical Sciences, Royal Infirmary, Ediburgh, United Kingdom.
Lee
A J
AJ
Ruckley
C V
CV
Bradbury
A W
AW
Ross
J A
JA
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000378:metabolism* / Q000401:mortality* / Q000601:surgery; D001019:Aortic Rupture / Q000378:metabolism* / Q000401:mortality* / Q000601:surgery; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D018124:Receptors, Tumor Necrosis Factor / Q000378:metabolism*; D013997:Time Factors
D018124:Receptors, Tumor Necrosis Factor