title: The grade-response relation between severity of peritonitis and serum cytokine concentrations explains Mannheim Peritonitis Index threshold.
abstract: OBJECTIVE
  To explore the gradient between the acute-phase response (APR) and peritonitis of differing severity.
  
  
  METHODS
  In 202 patients with peritonitis, we determined serum concentrations of interleukin (IL)-6, IL-10, IL-13, tumor necrosis factor (TNF)-alpha, and C-reactive protein (CRP). The severity of peritonitis was graded in accordance with the Mannheim Peritonitis Index (MPI). The grade-response relation between the severity of peritonitis and each analyte was explored.
  
  
  RESULTS
  A statistically significant association was found between the medians of severity of peritonitis and IL-6 (p < 0.025), TNF-alpha (p < 0.01), CRP (p < 0.033), IL-10 (p < 0.0001), and IL-13 (p < 0.004). Both TNF-alpha and IL-10 had a direct, and IL-13 an indirect, relation to severity, whereas CRP and IL-6 tended toward linear behavior in equilibrium. A significant association persisted between individual MPI scores and IL-6 (p < 0.002), TNF-alpha (p < 0.002), CRP (p < 0.002), and IL-10 (p < 0.001), but not IL-13 (p = 0.646).
  
  
  CONCLUSIONS
  Around the mean value of grade II peritonitis, the equilibrium between pro-inflammatory and anti-inflammatory cytokines is lost. This change coincides with the 26-point threshold for the MPI.
authors.affiliation: División de Estudios de Posgrado e Investigación, Universidad Juárez del Estado de Durango/Facultad de Medicina, Durango, Durango, Mexico. rudybracho@yahoo.com.mx
authors.forename: Rodolfo Leonel
authors.initials: RL
authors.lastname: Bracho-Riquelme
authors.forename: Miguel Arturo
authors.initials: MA
authors.lastname: Reyes-Romero
authors.forename: Alejandro
authors.initials: A
authors.lastname: Torres-Valenzuela
authors.forename: Ana Isabel
authors.initials: AI
authors.lastname: Flores-García
mesh_terms: D000328:Adult; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology*; D044967:Serum / Q000737:chemistry*; D012720:Severity of Illness Index
chemical_list: D016207:Cytokines