Characteristics of inflammatory mediators in systemic circulation of criticaly ill patients with secondary sepsis of peritonitis, pancreatitis and severe trauma

[S.B.Đukić]

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Uvod.Uloga imunskog odgovora u sepsi i dalje nije potpuno razjašnjena i predmet je istraživanja. Ciljevi:Utvrditi razlike u citokinskom profilu kod kritično obolelih bolesnika sa sepsom porekla pankreatitisa, peritonitisa i traume u odnosu na osnovno stanje, uzročnika i proceniti prognostičku vrednost u odnosu na ishod. Metode.Uzorci krvi uzeti su od 125 bolesnika sa sepsom porekla peritonitisa, pankreatitisa i traume, iz kojih su određeni nivoi proinflamatornih: TNF-α, IL-1α, IL-1β, IFN-γ, IL-6, IL-8, IL-12r70, IL-17A, IP 10, MCP1, MIP-1α, MIP-1β i antiinflamatornih citokina: IL-33, IL-31, IL-27, IL-13, IL-10, IL-4, prvog, a potom trećeg i petog dana. Rezultati. Nivoi TNF-α, MIP-1β, IL-1α, IP 10, MCP-1, IL-27, IL-33 i IL10 bili su veći u grupi peritonitisa u odnosu na pankreatitis prvog dana merenja. Poređenjem nivoa citokina između prvog, trećeg i petog dana merenja u grupi posttraumatske sepse ustanovljene su razlike za proinflamatorne: TNF-α, IL-1β, IP 10, IL-8, MIP-1β, IL-17A, IFN-γ, MIP-1α, IL-1α, IL-12p70 i anti-inflamatorne citokine: IL-33, IL-10, IL-31, IL-13. Razlike u nivoima citokina u pogledu bakterijemije ustanovili smo kod svih citokina, osim IL-8, trećeg dana merenja. Jedini prediktor letalnog ishoda prvog dana merenja bio je IL-17A kod bolesnika sa sepsom porekla peritonitisa. Zaključci. Citokinski profil kod pacijenata sa sepsom porekla peritonitisa pokazao je veće vrednosti u odnosu na pacijente sa sepsom kod teškog pankreatitisa u prvom danu merenja. Najniži nivoi citokina izmereni su kod pacijenata sa polimikrobnom hemokulturom. Niska koncentracija IL-17A kod pacijenata sa septičkim peritonitisom predviđa smrtni ishod.

Introduction: The role of the sepsis-related immune response has not been fully clarified, and still remains a subject matter of investigations. Objectives: to determine the differences in the cytokine profile in critically ill patients with sepsis of pancreatitis, peritonitis and trauma in relation to the underlying condition, the causative agent and to evaluate the prognostic value in relation to the outcome. Methods. Blood samples were taken from 125 patients with sepsis of peritonitis, pancreatitis and trauma origin, from which the levels of pro-inflammatory factors were determined:TNF-α, IL-1α, IL-1β, IFN-γ, IL-6, IL-8, IL-12p70, IL-17A, IP10, MCP-1, MIP-1α, MIP-1β and anti-inflammatory cytokines IL-33, IL-31, IL27, IL-13, IL-10, IL-4, the first, and then on the third and fifth day. Results. The levels of TNF-α, MIP-1β, IL-1α, IP 10, MCP-1, IL-27, IL-33 and IL-10 were higher in the group of peritonitis compared to pancreatitis on the first day of measurement. By comparing cytokine levels between the first, third and fifth day of measurement in the post-traumatic sepsis group, differences were found for pro-inflammatory: TNF-α, IL-1β, IP 10, IL-8, MIP-1β, IL17A, IFN-γ, MIP-1α, IL-1α, IL-12p70 and anti-inflammatory cytokines:IL-33, IL-10, IL-31, IL-13. Differences in cytokine levels with regard to bacteremia were found for all cytokines, except for IL-8, on the third day of measurement. The only predictor of lethal outcome on the first day of measurement was IL-17A in patients with sepsis of peritonitis origin. Conclusions. Cytokine profile in patients with sepsis of peritonitis origin showed higher values compared to patients with sepsis in severe pancreatitis on the first day of measurement. The lowest cytokine levels were measured in patients with polymicrobial blood cultures. Low concentration of IL-17A in patients with septic peritonitis predicts fatal outcome.

citokini, sepsa, peritonitis, pankreatitis, trauma, hemokultura, ishod, kritična stanja

cytokines, sepsis, peritonitis, pancreatitis, trauma, blood culture, outcome, critical illness

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