[Role of cytokines in the development of local and systemic inflammation and septic shock].

A central position in the development of systemic inflammation is played by activation of the vascular endothelium and monocyte- macrophage system. Both are associated with the formation of inflammatory cytokines, the primary mission of which is mobilization of the organism to cope with the infection. The so-called acute stage response develops with typical clinical manifestations and laboratory values. When it is impossible to stop the inflammation the syndrome of systemic inflammatory response develops with excessive activity of inflammatory cytokines and immune mechanisms. This apparently favourable system can be highly toxic for the organism and can lead to the syndrome of multiorgan failure, to disseminated intravascular coagulation, to depression of the myocardium, refractory vasodilatation, hypertension and septic shock. The compensatory antagonistic mechanism which develops due to the formation of anti-inflammatory cytokines leads sometimes to the development of a balanced state of immunity which is most favourable from the prognostic aspect. In case of their excess however immunodepression develops which is equally dangerous for the patient as excessive cytokine activity. From what has been said ensues the need of regular monitoring of patients with sepsis and thus also detailed investigation of their immune system.