The values of indices of non-specific resistance and cytokine regulation for early diagnosis of secondary peritonitis

M.M. Droniak; I.M. Shevchuk; S.S. Snizhko; I.Ya. Sadovyi; N.B. Fedorkiv; R.T.  Kuzenko

doi:10.26641/2307-0404.2023.3.288963

Авторы

M.M. Droniak Ivano-Frankivsk National Medical University, Halytska str., 2, Ivano-Frankivsk, 76000, Ukraine https://orcid.org/0000-0001-7976-0384
I.M. Shevchuk Ivano-Frankivsk National Medical University, Halytska str., 2, Ivano-Frankivsk, 76000, Ukraine https://orcid.org/0000-0001-6684-946X
S.S. Snizhko Ivano-Frankivsk National Medical University, Halytska str., 2, Ivano-Frankivsk, 76000, Ukraine https://orcid.org/0000-0001-5418-7825
I.Ya. Sadovyi Ivano-Frankivsk National Medical University, Halytska str., 2, Ivano-Frankivsk, 76000, Ukraine https://orcid.org/0000-0003-1476-7555
N.B. Fedorkiv Ivano-Frankivsk National Medical University, Halytska str., 2, Ivano-Frankivsk, 76000, Ukraine https://orcid.org/0000-0002-0987-0286
R.T. Kuzenko Ivano-Frankivsk National Medical University, Halytska str., 2, Ivano-Frankivsk, 76000, Ukraine https://orcid.org/0000-0003-1031-8787

DOI:

https://doi.org/10.26641/2307-0404.2023.3.288963

Ключевые слова:

secondary peritonitis, non-specific resistance, cytokine regulation

Аннотация

The aim of the work is to study the changes in indices of non-specific resistance and cytokine regulation, relevant for the early diagnosis of secondary peritonitis. During the period 2016-2022, in the Surgery Department of the Communal Non-Profit Enterprise “Regional Clinical Hospital, Ivano-Frankivsk Regional Council” there were treated 192 patients with postoperative peritonitis. Of them, in 69 (35.9%) patients the changes in indices of non-specific resistance and cytokine regulation were studied. These studies were performed in the laboratory of the Department of Biological and Medical Chemistry of the Ivano-Frankivsk National Medical University. The content of CD3⁺-lymphocytes in the blood of patients with secondary peritonitis on admission to the hospital was 35.49±3.39%, which is 1.8-fold less than in the comparison group (p<0.002), with their subsequent drop up to 31.00±2.88% (p<0.002) during the third day of the disease. When determining CD4⁺-lymphocytes during the first day of observation, their indices were 21.49±3.11%, by 56% less than in the comparison group (p<0.002). During the third day of the disease, we observed a slight increase in this index – up to 23.90±3.26% (p<0.01). The study of the level of CD8⁺-lymphocytes showed that, on admission to the hospital, their level in blood serum was 13.92±1.05%, which is 1.6-fold lower than in patients of the comparison group (p<0.002). Their decrease was observed further, and during the third day this index was 8.08±2.28% (p<0.002). The content of CD11a⁺-cells on hospitalization was 11.32±0.54%, which is more than 6-fold less than in the comparison group (p<0.002). The content of CD162⁺-cells in the blood on hospitalization was 21.49±3.11%, which is 3.1-fold less than in the comparison group (p<0.002). The content of CD16⁺-cells in the blood on hospitalization was 10.83±0.87% (p<0.002). A significant increase in the content of IL in the blood serum at the initial stage of secondary peritonitis with subsequent pathological changes are contributing factors in the disorder of the body’s immune response. The content of IL-6 on admission was 759.72±28.06%, which is almost 3.4-fold higher than the indices in the comparison group (p<0.002). After surgery, this index gradually decreased and during the seventh day was 438.63±19.84% (p<0.002). The results obtained on such indices of non-specific resistance and cytokine regulation as CD3+, CD4+, CD8+, CD11a, CD162, CD95, CD16, HLA-DR+, IL-2, IL-4, IL-6 showed their significant differences between the subgroups studied (p<0.002), indicating their high sensitivity for diagnosing and predicting the development of secondary peritonitis.

Библиографические ссылки

Dumitrascu CO, Gherghe M, Costache M, Cretu B, Cirstoiu C. The Role of Serum and Peritoneal Biomarkers in Predicting Sepsis and Septic Multiorgan Failure in Patients With Secondary Peritonitis. Cureus. 2023;15(7):e41724. doi: https://doi.org/10.7759/cureus.41724

Grondman I, Pirvu A, Riza A, Ioana M, Netea MG. Biomarkers of inflammation and the etiology of sepsis. Biochem Soc Trans. 2020;48(1):1-14. doi: https://doi.org/10.1042/BST20190029

Dong C. Cytokine Regulation and Function in T Cells. Annu Rev Immunol. 2021;39:51-76. doi: https://doi.org/10.1146/annurev-immunol-061020-053702

Tolonen M, Kuuliala K, Kuuliala A, Leppäniemi A, Kylänpää M-L, Sallinen V, Puolakkainen P, Mentula P. The Association Between Intra-abdominal View and Systemic Cytokine Response in Complicated Intra-abdominal Infections. Journal of Surgical Research [Internet]. 2019Dec.1;244:436-43. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022480419304731

Liu D, Huang SY, Sun JH, Zhang HC, Cai QL, Gao C, et al. Sepsis-induced immunosuppression: mechanisms, diagnosis and current treatment options. Mil Med Res. 2022;9(1):56. doi: https://doi.org/10.1186/s40779-022-00422-y

Clements TW, Tolonen M, Ball CG, Kirkpatrick AW. Secondary Peritonitis and Intra-Abdominal Sepsis: An Increasingly Global Disease in Search of Better Systemic Therapies. Scand J Surg. 2021;110(2):139-49. doi: https://doi.org/10.1177/1457496920984078

Montravers P, Assadi M, Gouel-Cheron A. Priori-ties in peritonitis. Curr Opin Crit Care. 2021;27(2):201-7. doi: https://doi.org/10.1097/MCC.0000000000000805

Sartelli M, Abu-Zidan FM, Labricciosa FM, Klu-ger Y, Coccolini F, Ansaloni L, et al. Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) Study: a WSES observational study. World J Emerg Surg. 2019;14:34. doi: https://doi.org/10.1186/s13017-019-0253-2

Martin-Loeches I, Timsit JF, Leone M, de Waele J, Sartelli M, Kerrigan S, et al. Clinical controversies in abdominal sepsis. Insights for critical care settings. Crit Care. 2019;53:53-8. doi: https://doi.org/10.1016/j.jcrc.2019.05.023

Koshelev RV, Vatazin AV, Zulkarnayev AB, Faenko AP. The state of the immune system in abdominal sepsis. Ter Arkh. 2019;91(2):82-6. doi: https://doi.org/10.26442/00403660.2019.02.000064

Hecker A, Reichert M, Reuß CJ, Schmoch T, Riedel JG, Schneck E, et al. Intra-abdominal sepsis: new definitions and current clinical standards. Langenbecks Arch Surg. 2019;404(3):257-71. doi: https://doi.org/10.1007/s00423-019-01752-7

Hanslin K, Sjölin J, Skorup P, Wilske F, Frithiof R, Larsson A, et al. The impact of the systemic inflammatory response on hepatic bacterial elimination in experimental abdominal sepsis. Intensive Care Med Exp. 2019;7(1):52. doi: https://doi.org/10.1186/s40635-019-0266-x

Godínez-Vidal AR, Verónica RH, Montero-García PJ, Martínez-Martínez AR, Zavala-Castillo JC, Graci-da-Mancilla NI. Evaluation of the serum procalcitonin level as an indicator of severity and mortality in abdominal sepsis due to secondary peritonitis. Cir Cir. 2019;87(3):255-9. doi: https://doi.org/10.24875/CIRU.18000301

Bensken WP, Ho VP, Pieracci FM. Basic Introduction to Statistics in Medicine, Part 2: Comparing Data. Surg Infect (Larchmt). 2021;22(6):597-603. doi: https://doi.org/10.1089/sur.2020.430

Coccolini F, Sartelli M, Sawyer R, et al. Source control in emergency general surgery: WSES, GAIS, SIS-E, SIS-A guidelines. World J Emerg Surg. 2023;18(1):41. doi: https://doi.org/10.1186/s13017-023-00509-4

Ho VP, Kaafarani H, Rattan R, Namias N, Evans H, Zakrison TL. Sepsis 2019: what surgeons need to know. Surg Infect (Larchmt). 2020;21(3):195-204. doi: https://doi.org/10.1089/sur.2019.126

Kao AM, Cetrulo LN, Baimas-George MR, Prasad T, Heniford BT, Davis BR, et al. Outcomes of open abdomen versus primary closure following emergent laparotomy for suspected secondary peritonitis: a propensity-matched analysis. J Trauma Acute Care Surg. 2019;87(3):623-9. doi: https://doi.org/10.1097/TA.0000000000002345