The influence of surgery on cytokines in patients with intra-abdominal sepsis.

The cytokine cascade which is triggered by severe sepsis may contribute to progressive organ dysfunction and death from sepsis. This cascade may be accentuated by surgery for sepsis and pre-treatment with cytokine blockers could possibly ameliorate the response. This prospective controlled study determined the effect of surgery in 11 haemodynamically stable patients undergoing laparotomy for intra-abdominal sepsis. Serum levels of endotoxin, IL-1, IL-6, IL-8 and TNF-alpha were determined; blood cultures, features of systemic inflammatory response, and organ dysfunction were monitored over the peri-operative period. There was considerable variation in the serum cytokine levels. The preoperative IL-6 levels were significantly elevated in the septic patients and a threefold increase in IL-6 levels occurred in both groups postoperatively. An increase in TNF-alpha did not achieve significance because of high levels in control patients with cancer. Cytokine release which occurs during abdominal surgery is increased in patients with intra-abdominal sepsis.