Cytokine clearance in serum and peritoneal fluid of patients undergoing damage control surgery with abdominal negative pressure therapy for abdominal sepsis

Nicolas Demartines,Martin Hübner,Seraina Faes,Dieter Hahnloser

doi:10.1515/pp-2020-0122

Abstract

ObjectivesOpen abdomen technique with negative pressure therapy (NPT) is widely used in patients with severe abdominal sepsis. The aim of this study was to evaluate cytokine clearance in serum and peritoneal fluid during NPT.MethodsThis prospective pilot study included six patients with severe abdominal sepsis requiring discontinuity resection and NPT for 48 h followed by planned reoperation. Cytokines (IL6, IL8, IL10, TNFalpha, and IL1beta) were measured in the serum and peritoneal fluid during index operation, on postoperative days 0, 1, and 2.ResultsConcentrations of cytokines in peritoneal fluid were higher than in serum. IL10 showed a clearance both in serum (to 16.6%, p=0.019) and peritoneal fluid (to 40.9%, p=0.014). IL6 cleared only in serum (to 24.7%, p=0.001) with persistently high levels in peritoneal fluid. IL8 remained high in both serum and peritoneal fluid. TNFalpha and IL1beta were both low in serum with wide range of high peritoneal concentrations. Only TNFalpha in peritoneal fluid showed significant differences between patients with ischemia vs. perforation (p=0.006).ConclusionsThe present pilot study suggests that cytokines display distinct patterns of clearance or persistence in the peritoneal fluid and serum over the first 48 h of treatment in severe abdominal sepsis with NPT.

Highlights

Abdominal sepsis is associated with significant morbidity and mortality due to multiorgan failure caused by systemic inflammatory response [1,2,3]
The present pilot study suggests that cytokines display distinct patterns of clearance or persistence in the peritoneal fluid and serum over the first 48 h of treatment in severe abdominal sepsis with negative pressure therapy (NPT)
Pro-inflammatory cytokines induced by different endo- or exogenous triggers play an important role in initiating inflammatory response and regulating host defense. This cytokine cascade is initiated upon a direct toxic effect of pathogens like bacteria and intestinal fluid after bowel perforation or upon release of toxic metabolites like lactate, reactive oxygen metabolites, and nitric monoxide in mesenteric ischemia

Summary

Introduction

Abdominal sepsis is associated with significant morbidity and mortality due to multiorgan failure caused by systemic inflammatory response [1,2,3]. IL10 is an anti-inflammatory cytokine that enhances antibody response by CD4+ T-cell activation, costimulatory molecules on macrophages and suppression of secretion of pro-inflammatory cytokines triggered by bacterial products and lipopolysaccharide [24,25,26,27,28]. It is elevated post abdominal surgery and decreases in the postoperative course of patients without complications [29].

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