Comparison of inflammatory cytokines in peritoneal fluid at source control surgery for abdominal sepsis.

BACKGROUND

Open abdomen with vacuum assisted closure (VAC) is an alternate method to primary abdominal closure (PAC) in select situations for the management of severe surgical abdominal sepsis or septic shock. Peritoneal cytokines may potentially correlate with deranged physiology and help stratify severity of sepsis. The primary objective of the study was to identify if cytokines can differentiate between patients who underwent PAC or VAC at primary source control laparotomy (SCL).

METHODS

Prospective case series including patients with severe abdominal sepsis/septic shock requiring urgent SCL. Peritoneal fluid (PF) was collected intra-operatively and blood samples were collected pre- and post SCL. Samples were analyzed with a Cytokine 30-plex Panel. APACHE-IV was used as a measure of disease severity between groups.

RESULTS

4 PAC and 8 VAC patients were included. PF concentrations of IL 6, IL-17, IL-5 and HGF were significantly elevated in VAC compared to PAC. Serum RANTES was increased in survivors compared to non-survivors.

CONCLUSIONS

Patients who received VAC management had a more severe degree of local abdominal sepsis based on significantly elevated peritoneal cytokines.