CYTOKINE RESPONSE AND OTHER DIFFERENCES BETWEEN CRITICAL PHASES OF SEPSIS-ASSOCIATED SYSTEMIC INFLAMMATION

Abstract

Acute sepsis (1-3 days after admission) has been compared with tertiary peritonitis, as a clinical variant of prolonged sepsis (7 to 42 days after admission). A total of 153 patients were enrolled into the study, including 112 cases of multiple organ dysfunction syndrome (MODS, as assessed by SOFA score), of them thirty-one with septic shock; fatal outcomes, in 48 cases. Plasma concentrations of C-reactive protein, cytokines (IL-6, IL-8, IL-10, TNFα), cortisol, troponin I, myoglobin, D-dimer were detected by means of immunochemiluminesce assay (ImmuLite). Development of systemic inflammation (SI) was evaluated by appropriate integral criteria. An association was established between SI development and critical complications in the both groups of patients. Meanwhile, hyperergic variants of SI development associated with high cytokine levels, proved to prevail in acute sepsis. On the contrary, hypoergic variants were more common in cases of tertiary peritonitis, being characterized by relatively low levels of cytokines, along with higher probability of other SI syndromes and risks of lethal outcomes. In summary, systemic inflammatory events in acute versus prolonged sepsis may proceed by different pathogenetic pathways.

Keywords

• sepsis
• tertiary peritonitis
• systemic inflammation
• cytokines