Large Abdominal Surgery Research Articles

Inflammation Disturbed the Tryptophan Catabolites in Hippocampus of Post-operative Fatigue Syndrome Rats via Indoleamine 2,3-Dioxygenas Enzyme and the Improvement Effect of Ginsenoside Rb1.

AimPost-operative fatigue syndrome (POFS) is a common complication that prolongs the recovery to normal function and activity after surgery. The aim of the present study was to explore the mechanism of central fatigue in POFS and the anti-fatigue effect of ginsenoside Rb1.MethodWe investigated the association between inflammation, indoleamine 2,3-dioxygenase (IDO) enzyme, and tryptophan metabolism in the hippocampus of POFS rats. A POFS rat model was induced by major small intestinal resection. Rats with major small intestinal resection were administered ginsenoside Rb1 (15 mg/kg) once a day from 3 days before surgery to the day of sacrifice, or with saline as corresponding controls. Fatigue was assessed with the open field test (OFT) and sucrose preference test (SPT). ELISA, RT-PCR, Western blot, immunofluorescence, and high-performance liquid chromatography (HPLC) were used to test the inflammatory cytokines; p38MAPK, NF-κB/p65, and IDO enzyme expressions; and the concentrations of tryptophan, kynurenine, and serotonin, respectively.ResultOur results showed that POFS was associated with increased expressions of inflammatory cytokines and p38MAPK and higher concentrations of kynurenine and tryptophan on post-operative days 1 and 3; a lower serotonin level on post-operative day 1; and an enhanced translocation of NF-κB/p65 and the IDO enzyme on post-operative days 1, 3, and 5. Ginsenoside Rb1 had an improvement effect on these.ConclusionInflammatory cytokines induced by large abdominal surgery disturb tryptophan metabolism to cause POFS through the activation of the p38MAPK–NF-κB/p65–IDO pathway in the hippocampus. Ginsenoside Rb1 had an anti-fatigue effect on POFS by reducing inflammation and IDO enzyme.

Intraperitoneal microdialysis detects intestinal leakage earlier than hemodynamic surveillance and systemic inflammation in a pig model

Objective Anastomotic leakage is a common complication following large abdominal surgery, often developing to life-threatening abdominal sepsis due to late diagnosis. Currently, diagnostics rely on systemic hemodynamic and infection monitoring. We hypothesized that intraperitoneal microdialysis allows detection of peritonitis prior to changes in standard clinical parameters in a pig model. Materials and Methods We included six pigs; five underwent intraperitoneal fecal contamination, one had sham surgery for a total of 10 h. Microdialysis was established in four intraabdominal quadrants and two hepatic lobes. All pigs were hemodynamically monitored with pulmonary artery and femoral artery catheters. Blood samples were assessed for inflammatory markers, terminal complement complex (TCC), interleukin (IL)-6, IL-10, and plasminogen activator inhibitor-1 (PAI-1). Results Microdialysis showed intraperitoneal lactate increase during the first two hours after fecal contamination, which remained elevated throughout the observation time with concurrent decrease of glucose. Arterial lactate remained within reference range (<1,6mM). Systemic inflammatory markers TCC, IL-6, IL-10 and PAI-1 increased significantly after minimum four hours. Mean arterial pressure, stroke volume variation and cardiac output were not compromised the first five hours. Sham surgery did not influence any of the parameters. Conclusion Intraperitoneal fecal contamination leads to a rapid and pronounced intraperitoneal increase in lactate, decrease in glucose while pyruvate and glycerol levels remain unchanged. This distinct metabolic pattern of peritoneal inflammation can be easily detected by microdialysis. Observation of this pattern may minimize time to safe diagnosis of intestinal perforations after intraperitoneal fecal contamination.

SUPPORTING DEVICES IN THE TREATMENT OF CHRONIC HEART FAILURE IN ELDERLY AND OLD PATIENTS

Chronic heart failure (CHF) is a widespread disease associated with high rates of disability and mortality, as well as a decrease in the quality of life. Moreover, the vast majority of patients are elderly and senile. Modern surgical methods of treating heart failure are able to increase the duration and quality of life of such patients, however, the need far exceeds the volume of this care, and some highly effective methods common in Western countries are still not used in Russian clinical practice.&#x0D; Elderly age is a risk factor for the development of senile asthenia (frailty) and concomitant pathology. Large abdominal surgery is often contraindicated for patients with signs of senile asthenia, and the method of choice in patients with severe heart failure is the implantation of devices for long-term mechanical circulatory support (LT-MCS). After implantation of LT-MCS, a regression of signs of senile asthenia may be observed.&#x0D; The topic of an integrated approach to non-drug treatment of heart failure in elderly and senile patients in Russia has not been studied enough. In particular, the implantation of LT-MCS is not used in Russian clinical practice, while in many Western countries for many years it has been the main and most effective treatment for severe heart failure. Systematization of the available up-to-date information on this topic could help increase the duration and quality of life of patients with severe heart failure.

Our Experience in Epidural Analgesia Following Large Abdominal Surgeries.

Background: Epidural analgesia is a gold standard in post-operative pain control in patients undergoing large abdominal interventions. Different studies report a failure ratio of epidural analgesia of 20-32%.&#x0D; The aim of this study is to analyze the success rate of epidural analgesia and its consequences in patients that have been subject to large abdominal surgeries.&#x0D; Materials and methods: We have prospectively collected the data of 50 patients that were subject to open abdominal surgeries during a 2 year timeframe (September 2015 – September 2017) at University Clinical Center of Kosovo. Experienced anesthesiologists inserted the epidural catheters. A dedicated team used the Verbal Scale to collect the data regarding post-operative pain during coughing or moving. The success rate of eidural catheter was measured in terms of: the scale of pain, pulmonary post-operative infection and length of hospital stay.&#x0D; Results: The study group included 33 males and 17 females, most of whom were subject to liver surgery. The secondary liver formations (70%), primary tumours (20%) as well as beningn liver disorders(10%) were an indication for liver resection. Large resections (≥3 segments) were completed in 44% of patients, small liver resections were (≤2 segments) completed in 48% of patients, while 8% of patients were considered inoperative. Epidural analgesia was successful in 46 patients (92%). Bacterial colonisation of the catheter was observed in only one case. There were no neurological complications. 5 (10%) patients showed radiologicalsigns of a pulmonary infection. Three patients (6%) had surgical wound infection. One patient died of hepatic insufficiency after massive right liver resection and cholecystectomy due to gallbladder carcinoma. The average length of hospital stay was 6 days.&#x0D; Conclusions: Our experience concludes that epidural analgesia is a safe and effective way of pain relief after abdominal surgeries.

Therapeutic Reduction of Intraoperative Blood Loss by Terlipressin in Abdominal Surgery

Aim. To determine the efficiency of selective vasoconstrictor terlipressin in blood loss reduction during large abdominal surgery. Material and Methods. Results of abdominal surgical operations in two comparable clinical groups (1st control group of 30 patients and 2nd research group of 38 patients) in aspect of intraoperative blood loss volume are analyzed. Patients underwent liver resection, pancreatic resection, biliodigestive reconstructive surgery and splenectomy for “huge” spleen. Intraoperative blood loss and some parameters of postoperative period were studied. Patients of the 2nd group received terlipressin (Remestyp®) 1000–3000 μg intravenously in addition to standard surgical procedures to reduce blood loss. Results. An optimal algorithm of terlipressin (Remestyp®) administration for blood loss reduction during abdominal surgery was determined: 1000 μg for 30 minutes before intervention plus 500–1000 μg during operation and 1000 μg if duration of surgery is over than 4 hours. There is the most demonstrative reduction of blood loss in cases of repeated biliodigestive reconstructions and splenectomy for “huge” spleen – 484.2 ± 36.1 ml vs. 352.8 ± 22.5 ml (р &lt; 0.01) and 560.4 ± 76.2 ml vs. 314.2 ± 38.8 ml (р &lt; 0.01). Conclusion. Surgical technique is most important factor for blood loss reduction in abdominal interventions. However sometimes intraoperative use of terlipressin is substantively effective. Selective vasoconstrictor-assisted upper abdominal surgery in patients with portal hypertension should be obligatory

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a review of factors contributing to morbidity and mortality.

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with prolonged survival for appropriately selected patients with peritoneal dissemination of abdominal malignancies. CRS and HIPEC has been criticized for perceived high rates of morbidity and mortality. Morbidity and mortality rates of CRS and HIPEC, however, do not appear dissimilar to those of other large abdominal surgeries, particularly when relevant patient and operative factors are accounted for. The risk of morbidity and mortality following this surgery for a given individual can be predicted in part by a variety of patient and operative factors. While strong data are lacking, the limited data that exists on the matter suggests that the independent contribution of the heated intraperitoneal chemotherapy to CRS and HIPEC morbidity is relatively small. A more thorough understanding of the patient and operative factors associated with CRS and HIPEC morbidity and mortality, as well as the specific complications related to the intraperitoneal chemotherapy, can better inform clinicians in multidisciplinary teams and patients alike in the decision-making for this surgery.

Intensive care unit admission after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Is it necessary?

Introduction. Cytoreductive surgery (CS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a new approach for peritoneal carcinomatosis. However, high rates of complications are associated with CS and HIPEC due to treatment complexity; that is why some patients need stabilization and surveillance for complications in the intensive care unit. Objective. This study analyzed that ICU stay is necessary after HIPEC. Methods. 39 patients with peritoneal carcinomatosis were treated according to strict selection criteria with CS and HIPEC, with closed technique, and the chemotherapy administered were cisplatin 25 mg/m2/L and mitomycin C 3.3 mg/m2/L for 90-minutes at 40.5°C. Results. 26 (67%) of the 39 patients were transferred to the ICU. Major postoperative complications were seen in 14/26 patients (53%). The mean time on surgical procedures was 7.06 hours (range 5−9 hours). The mean blood loss was 939 ml (range 100–3700 ml). The mean time stay in the ICU was 2.7 days. Conclusion. CS with HIPEC for the treatment of PC results in low mortality and high morbidity. Therefore, ICU stay directly following HIPEC should not be standardized, but should preferably be based on the extent or resections performed and individual patient characteristics and risk factors. Late complications were comparable to those reported after large abdominal surgery without HIPEC.

Fast‐track rehabilitation after robot‐assisted laparoscopic cystectomy accelerates postoperative recovery

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: There is evidence from large abdominal surgeries and some open cystectomy series that multifactorial fast-track regimens shorten postoperative convalescence without any effect on morbidity and mortality. Such a regimen is of particular interest in combination with minimally invasive techniques, as early patient recovery demands for more rapid nutrition and mobilisation schemes. The present study, in a single institution, reports on the design, application and results of a fast-track protocol in patients undergoing robot-assisted laparoscopic cystectomy. There was no evidence of a higher incidence of complications with the fast-track regimen and postoperative recovery was faster. To evaluate the feasibility and effectiveness of a multifactorial fast-track (FT) regimen on perioperative outcomes in patients undergoing robot-assisted laparoscopic cystectomy (RALC) with extracorporeal urinary diversion. To point out that morbidity and mortality of radical cystectomy have improved markedly over the last decades and RALC is an emerging technique showing further advances in postoperative recovery, thus demanding for more rapid nutrition and mobilisation schemes. A non-randomised cohort study of 63 patients who underwent RALC at one institution between January 2007 and March 2010. In all, 31 patients underwent RALC without FT and 31 RALC with FT. One patient required conversion to open surgery and was therefore excluded from the study. The FT regimen included early nutrition and the quickest possible mobilisation, while mechanical bowel preparation before surgery, as well as preoperative fasting and nasogastric or abdominal drains after surgery, were omitted. Demographics, perioperative and complication data (according to modified Clavien system), as well as required opioid pain medication were documented prospectively and compared between RALC patients with and without FT. Groups were comparable for demographics, risk factors and clinical stage as well as operative parameters, e.g. mean operating room time, estimated blood loss, lymph nodes removed and postoperative haemoglobin level. In the FT group, abdominal drains were mostly omitted and nasogastric tubes were removed immediately after surgery. There were significant differences in the mobilisation within the room (17.5 vs 31.2 h), the time to a regular diet (4.0 vs 6.6 days) and a remarkably lower use of postoperative morphine equivalents (57.3 vs 92.4 mg) for patients receiving FT. There were no significant differences in the overall complication rates or major complications based on Clavien classification. The informative value of the study is limited by its single-centre, non-randomised design, a relatively small sample size and a possible learning curve bias. Combining RALC with FT is feasible in the perioperative treatment of these patients. Multifactorial postoperative regimens seem to quicken postoperative recovery of RALC patients without increasing their risk of postoperative complications.

Perioperative Analgesia for Patients Undergoing Open Liver Resection: Epidural or Paravertebral?

Open liver resection is a painful surgery, and patients clearly benefit from regional anesthesia for pain management in the perioperative period. However, it is still unclear which regional block technique is superior in these patients. Epidural Analgesia in Open Liver Resection Although simple liver resection is increasingly done laparoscopically, patients with large liver masses or previous abdominal surgery often undergo an open liver resection. This requires a long right subcostal incision, the associated pain of which may carry significant morbidity in the post-operative period. The best-studied regional technique in abdominal as well as thoracic procedures is thoracic epidural block. Decreasing nociceptive input via epidural analgesia reduces activation of sympathetic outflow, thus reducing surgical stress, which negatively impacts many organ systems (1). Epidural analgesia decreases pain-related tachycardia and hypertension, which could cause perioperative myocardial ischemia. Furthermore, thoracic and upper abdominal nociceptive input activates reflex inhibition of diaphragmatic excursion and increased expiratory intercostal and abdominal muscle tone, leading to increased atelectasis and risk of pneumonia. One study of 915 major abdominal surgical patients revealed that epidural analgesia both decreased pain scores in the first three postoperative days and decreased rates of respiratory failure (2). Interestingly, a handful of studies have also documented a positive impact of epidural analgesia on the coagulation profile, which prevents post-operative thromboembolic complications (1). Other benefits include a decrease in stress-induced gastrointestinal disruption and immunosuppression. Moreover, in patients undergoing open liver resection, epidural technique resulted not only in improved analgesia, but also in decreased postoperative morphine consumption (3), the latter of which is an additional benefit of epidural analgesia, given the potentially deleterious side effects associated with intravenous (IV) opioids (i.e., respiratory depression, decreased gastrointestinal motility). Indeed, epidural analgesia was sufficient for 80% of patients undergoing open liver resection in another study, with only 20% of patients requiring additional analgesia with IV opioids (4).

Evaluation of Intraabdominal Presure changes after large Abdominal hernia Surgeries

Evaluation of Intraabdominal Presure changes after large Abdominal hernia Surgeries

Procalcitonin in Early Detection of Postoperative Infectious Complications. the Comparison with a Set of Cytokines, Soluble Cytokine Receptors and Acute Phase Proteins

Background: Infections and sepsis are relevant complications in patients undergoing large abdominal surgery and still constitute a diagnostic challenge. Only limited markers can differentiate incipient postoperative sepsis from uncomplicated early postoperative reaction. A prospective clinical study was performed to examine the accuracy of procalcitonin (PCT), set of cytokines, soluble cytokine receptors and acute phase proteins in patients following major abdominal surgery. Subjects and Methods: Between January 2006 and February 2008, 48 patients with febrile episode of the early postoperative period after abdominal surgery were entered into the study. Blood samples were obtained on the first day of fever for the measurement of plasma PCT (Kryptor), TNFalpha, IL-1beta, IL-1ra, IL-2, IL-6, sIL-6R, IL-8 (ELISA), and 10 acute phase proteins (nephelometry). Data were compared with reference group: 24 patients with the planned resection of colorectal cancer at stage Ib-IV and uncomplicated healing; venous blood samples were obtained repeatedly before surgery, 6, 12, 18, 24, 48, and 72 h after start of surgery Results: Febrile reaction of 26/48 patients was linked with positive blood culture results. PCT and IL-6 concentrations of blood culture positive subjects differed significantly from non-bacteremic patients (p < 0.01 for both parameters) as well as from uncomplicated patients (p < 0.003 and p < 0.001). Cutoff levels to distinguish blood culture positive and negative subgroups using ROC were 0.96 ng/ml for PCT and 345 pg/ml for IL-6. Other inflammatory parameters showed high sensitivity but lower specificity for bacterial complications in relation to uncomplicated postsurgical course. PCT and monitored cytokines culminated 18—36 h following uncomplicated surgery and postoperative PCT levels did not exceed 1.02 ng/ml in this group Conclusions: Simultaneous PCT and IL-6 examination is a reliable approach to distinguish incipient infectious complications in early postoperative period. Their measurement is well founded for daily monitoring of high-risk patients after large abdominal surgical procedures. Supported with grant IGA-MZ-CR-4825—3.

Ghrelin as an Acute-phase Reactant during Postoperative Stress Response

Ghrelin is a growth hormone-releasing peptide, discovered in 1999 by Kojima et al. Its potential role in inflammation and stress response is not yet clear. The purpose of this study was to characterize perioperative levels of circulating ghrelin in relation to different surgical procedures. The authors compared plasma ghrelin changes with cortisol, cytokines, and acute-phase proteins. The prospective study was performed on 22 patients with resection for colon cancer (group 1). Group 2, functioning as a comparative group, consisted of 22 patients with elective laparotomic cholecystectomy. Plasma concentrations of ghrelin, cortisol, tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta, IL-6, IL-8, soluble IL-2 receptor, C reactive protein, and alpha1-antitrypsin were estimated repeatedly during a 72-hour postoperative period. Data revealed significant elevation of plasma ghrelin 24 hours after resection of coli (median 508.0 ng/l, interquartile range 398.2-633.7 ng/l) in relation to both preoperative levels (317.6 ng/l, 253.4-355.1 ng/l, p<0.01) and group 2 maximal postoperative levels (386.2 ng/l, 324-432 ng/l, p<0.05). Ghrelin levels returned to initial status 36-48 hours after surgery with subsequent decline to subnormal levels. The regression coefficient was the highest for ghrelin and TNF-alpha 24 hours after laparotomy (r=0.64, p<0.05) and for ghrelin and IL-6 24 hours after surgery (r=0.56, p<0.05). Maximal postoperative levels of all tested parameters except for cortisol and IL-1beta differed significantly between both patient groups at p<0.05. After large abdominal surgery, ghrelin shows itself as an acute-phase reactant. The significant correlation between ghrelin and inflammatory cytokines supposes their regulatory role in this period. Our comparison of more- and less-invasive surgical procedures with similar nutritional restrictions argues for a dominant role of inflammatory factors in postoperative ghrelin elevation.

Hepatic Resection-Related Hypophosphatemia Is of Renal Origin as Manifested by Isolated Hyperphosphaturia

Giovannini, Ivo MD; Chiarla, Carlo MD; Giuliante, Felice MD; Ardito, Francesco MD; Vellone, Maria MD; Nuzzo, Gennaro MD Author Information

Ghrelin and Leptin Elevation in Postoperative Intra-Abdominal Sepsis

Background: Both ghrelin and leptin are important signals in the regulation of food intake and energy balance. Leptin concentrations are elevated in the majority of obese individuals, and its levels usually correlate with adiposity and body mass index. Ghrelin as a new growth hormone (GH)-releasing peptide was discovered in 1999. Ghrelin stimulates food intake and exhibits gastroprotective properties. Many other regulatory effects of both ghrelin and leptin involving cardiovascular, gastrointestinal, renal, and endocrine systems were revealed. New experimental studies show both hormones as new acute phase reactants in animal models of inflammatory reaction. The aim of this study was to characterize the levels of circulating ghrelin and leptin in relation to systemic inflammatory response. We used a postoperative bacterial sepsis after large abdominal surgery as a model of cytokine network hyperstimulation. Patients and Methods:The prospective study was performed on 25 surgical patients with proven postoperative intra-abdominal sepsis after large abdominal surgery. Plasma levels of ghrelin (RIA), leptin, TNF-α, IL-1β, sIL-2R, IL-6 (ELISA analysis), CRP and α₁-antitrypsin (nephelometric analysis) were analyzed. Results: Authors demonstrate statistically significant elevation of plasma ghrelin (492.3 ± 70.6 ng/l) and leptin (31.6 ± 12.2 µg/l) compared with the control group (336.5 ± 46,1, p < 0.01 for ghrelin, 3.5 ± 1.2 µg/l, p < 0.001 for leptin). The regression coefficient was the highest for ghrelin and IL-6 (r = 0,44, p < 0.05), and for ghrelin and TNF (r = 0.43, p < 0.05) in the sepsis group. In regard to leptin, the regression coefficient was the highest for IL-6 and leptin (r = 0.53, p < 0.05) and for leptin and CRP (r = 0.51, p < 0.05). There was no significant correlation between ghrelin and IL-1β, ghrelin and sIL-2R, and leptin and IL-1β. Conclusions: During postoperative intra-abdominal sepsis, both ghrelin and leptin plasma levels are elevated and positively correlate with both inflammatory cytokines (TNF-α, IL-6) and main APP member (CRP). It supports experimental finding that TNF-α and IL-6 can be important regulatory factors of their synthesis. This hormonal reaction is not specific to sepsis – the significant increase of both ghrelin and leptin occurs during an uncomplicated postoperative response, although in a lesser extent than was shown in sepsis.

Preoperative feeding preserves heart function and decreases oxidative injury in rats

Objective The nutritional status of a patient has been implicated as an important factor in the development of postoperative complications. Fasting before an operation may have detrimental effects on the metabolic state. We hypothesized that there was a positive correlation between preoperative nutritional status and postoperative organ function. Methods Preoperative feeding was compared with fasting with respect to effects on organ function and biochemical parameters in an animal model of extensive large abdominal surgery. Male Wistar rats were fed ad libitum or fasted for 16 h, after which the arteria mesenterica superior was clamped for 60 min followed by 180 min of reperfusion. Results After the ischemic period, heart function was significantly better in animals that were fed ad libitum than in fasted animals. Moreover, after intestinal ischemia and reperfusion, fed rats showed significantly higher levels of intestinal adenosine triphosphate and a significantly higher malondialdehyde concentration in the intestine and lung than did fasted rats. The ratio of adenosine triphosphate to adenosine diphosphate in the liver, an indicator of energy status, in fed rats was similar to that in a sham group, whereas fasted animals showed a significantly lower value. Conclusions Preoperative nutrition in contrast to fasting may attenuate ischemia/reperfusion-induced injury and preserve organ function in the rat.

Effect of dai-kenchu-to on obstructive bowel disease in children.

The aim of this study was to evaluate the effects of a traditional Chinese herbal medicine, dai-kenchu-to (DKT), on obstructive bowel diseases in children. We have treated 46 pediatric patients with various obstructive bowel diseases with DKT: six patients with postoperative ileus, 12 with large abdominal surgery (including three neonates), one with ano-rectal anomaly, three with Hirschsprung's disease, two with functional bowel obstructions, one with SMA syndrome, and 21 patients with chronic constipation. DKT (0.1-0.15 g/kg) was mixed with 5-10 ml of warm water, and was given orally two to three times a day. DKT was effective for 39 patients (85%) and their clinical symptoms improved. DKT was ineffective in seven patients: two with postoperative ileus, two with Hirschsprung's disease, and three with chronic constipation. DKT had mild but significant effects for various obstructive bowel diseases in children, while no side effects were encountered. Our current strategy for pediatric patients with obstructive bowel disease is to use DKT first and then test its efficacy. If DKT is effective, the regimen is continued. However, in cases where DKT is not effective, we will consider laparotomy or will further investigate the illness.

Serum leptin levels in septic men correlate well with the C-reactive protein (CRP) and TNF-alpha but not with BMI

Leptin, an adipocyte-derived signaling factor, is a member of the IL-6 cytokine family. However there is no direct evidence of leptin stimulation of the acute phase protein (APP) synthesis which is typical for all other IL-6-like factors. The purpose of this study was to characterize the dynamics of circulating leptin in relation to ten APPs. We used postoperative septic patients as a model of cytokine network hyperstimulation and intensive APP reaction. The prospective study was performed on 22 patients with proven postoperative intraabdominal sepsis after large abdominal surgery. Plasma levels of leptin, TNF-a, IL-1ß, soluble IL-2 receptor (sIL-2R), IL-6 (ELISA analysis) and ten APPs (nephelometric analysis) were estimated. We have demonstrated a statistically significant elevation of plasma leptin concentrations in the septic group compared with healthy subjects (p&lt;0.001). The correlation of plasma leptin and BMI during postoperative sepsis was diminished. The regression coefficient was the highest for leptin and CRP (r=0.48, p&lt;0.05), and for leptin and alpha-1-antitrypsin (r=0.46, p&lt;0.05) in the septic group. There was significant correlation between TNF-a and leptin (r=0.47, p&lt;0.05) and between IL-6 and leptin (r=0.45, p&lt;0.05) in septic patients. No significant correlation was found between leptin and "negative" APP and between leptin and IL-1ß. Leptin has thus been shown as an acute phase reactant with a potential hematopoietic, immunomodulatory and hepatocyte stimulating activity during the infectious and non-infectious stress response. The significant correlation between leptin and CRP and leptin and alpha-1-antitrypsin indicates that leptin can participate in APP synthesis regulation during a systemic inflammatory response.