Zhao Jie, Zhang Teng, Deng Zhe, Han Xia, Ma Tao, Xie Keliang
Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, People's Republic of China.
Tianjin Medical University, Tianjin, People's Republic of China.
J Inflamm Res. 2023 Feb 24;16:809-826. doi: 10.2147/JIR.S401428. eCollection 2023.
Intra-abdominal infection is considered the second most common cause of sepsis and results in localized or diffused inflammation of the peritoneum. The main treatment for abdominal sepsis is an emergency laparotomy for source control. However, surgical trauma also causes inflammation, and patients become susceptible to postoperative complications. Therefore, it is necessary to identify biomarkers that can be used to distinguish sepsis from abdominal infection. This prospective study investigated whether cytokine levels in the peritoneum could predict complications and indicate severity of sepsis following emergency laparotomy.
We prospectively observed 97 patients with abdominal infection admitted to the Intensive Care Unit (ICU). After emergency laparotomy,SEPSIS-3 criteria were used for the diagnosis of sepsis or septic shock. Blood and peritoneal fluid samples were drawn at postoperative admission to the ICU and cytokine concentrations were measured by flow cytometry.
Fifty-eight postoperative patients were enrolled. We found significant elevations in the peritoneal concentrations of IL-1β, IL-6, TNF-α, IL-17, and IL-2 in patients with sepsis or septic shock compared to the patients without sepsis after surgery. Positive correlations between levels of these peritoneal cytokines with APACHE II scores were found: IL-6, in particular, had the highest correlation coefficient of 0.833. Meanwhile, IL-10 in blood, MCP-1 and IL-8 in both blood and peritoneum were simultaneously increased in patients with sepsis and septic shock, and also positively correlated with disease severity.
The cytokine storm that occurs in the abdominal cavity after emergency laparotomy may be the main mechanism leading to sepsis. It may be valuable to measure IL-1β, IL-6, TNF-α,IL-17, IL-2, MCP-1, and IL-8 in the peritoneal fluid, combined with serum IL-10, MCP-1 and IL-8, in a panel of cytokines, to assess the severity of sepsis and predict mortality from abdominal infection after emergency laparotomy.
腹腔内感染被认为是脓毒症的第二大常见病因，可导致腹膜局部或弥漫性炎症。腹部脓毒症的主要治疗方法是进行急诊剖腹手术以控制感染源。然而，手术创伤也会引发炎症，患者术后易出现并发症。因此，有必要识别可用于区分脓毒症与腹部感染的生物标志物。这项前瞻性研究调查了腹腔内细胞因子水平是否能够预测急诊剖腹手术后的并发症并提示脓毒症的严重程度。
我们前瞻性观察了97例入住重症监护病房（ICU） 的腹部感染患者。急诊剖腹手术后，采用脓毒症-3标准诊断脓毒症或脓毒性休克。术后入住ICU时采集血液和腹腔液样本，通过流式细胞术检测细胞因子浓度。
纳入58例术后患者。我们发现，与术后未发生脓毒症的患者相比，发生脓毒症或脓毒性休克的患者腹腔内白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、白细胞介素-17（IL-17）和白细胞介素-2（IL-2）浓度显著升高。发现这些腹腔细胞因子水平与急性生理与慢性健康状况评分系统II（APACHE II）评分呈正相关：尤其是IL-6，其相关系数最高，为0.833。同时，脓毒症和脓毒性休克患者血液中的IL-10以及血液和腹腔内的单核细胞趋化蛋白-1（MCP-1）和IL-8均同时升高，且与疾病严重程度也呈正相关。
急诊剖腹手术后腹腔内发生的细胞因子风暴可能是导致脓毒症的主要机制。在一组细胞因子中，检测腹腔液中的IL-1β、IL-6、TNF-α、IL-17、IL-2、MCP-1和IL-8，并结合血清IL-10、MCP-1和IL-8，对于评估脓毒症的严重程度以及预测急诊剖腹手术后腹部感染的死亡率可能具有重要价值。
