Inflammatory Response in Peritoneal Exudate and Plasma of Patients Undergoing Planned Relaparotomy for Severe Secondary Peritonitis

Abstract

Secondary peritonitis is associated with a significant cytokine-mediated inflammatory response that is compartmentalized in the peritoneal cavity and indicates an adverse prognosis. Levels of cytokines in the exudate of peritonitis may be used to better stratify the severity of peritonitis and, in future, to guide local therapy.

Management of Peritonitis in the Critically Ill Patient

“…If the host is healthy or bacteremia is not massive, it will be controlled without any other systemic repercussion. If, on the contrary, the host is jeopardized or bacteremia is very great, a systemic inflammatory response with commitment of the patient (sepsis) can be produced [16,17].…”

Serial Evaluation of Abdominal Fluid and Serum Amino‐terminal pro‐C‐type Natriuretic Peptide in Dogs with Septic Peritonitis

“…It has been suggested that the low serum NT‐proCNP concentrations in dogs with SP may be explained by sequestration of NT‐proCNP in the abdominal cavity, such that NT‐proCNP concentration of abdominal fluid may provide a potential biomarker for the diagnosis of SP 4. This concept of compartmentalization has been previously described using other biomarkers in human patients with SP 8, 9. Indeed, human studies report higher cytokine concentrations including IL‐1, IL‐6, IL‐10, and TNF‐α in the abdominal fluid compared to plasma during SP 8, 9.…”

“…This concept of compartmentalization has been previously described using other biomarkers in human patients with SP 8, 9. Indeed, human studies report higher cytokine concentrations including IL‐1, IL‐6, IL‐10, and TNF‐α in the abdominal fluid compared to plasma during SP 8, 9. It has also been shown in rat models of sepsis‐induced peritonitis that accumulation of fibrin, leukocytes, and erythrocytes could obstruct the peritoneal stomata, thereby decreasing the peritoneal permeability and impairing the clearance of various intra‐abdominal cytokines 17…”

“…In this study, abdominal fluid was centrifuged within an hour of collection and stored at −80°C, as recommended by the ELISA manufacturer for the measurement of NT‐proCNP in serum. Such abdominal fluid processing has also been reported in previously published studies evaluating cytokine concentrations and acute phase protein concentrations in the abdominal fluid of human patients for potential diagnostic/screening purposes 8. Abdominal fluid sample handling and the effects of freezing and storage on NT‐proCNP concentrations have not been studied.…”

“…Indeed, dogs with SP had low serum NT‐proCNP concentrations that were comparable to those of healthy or NSIRS dogs 4. One potential explanation for these findings is that NT‐proCNP could be concentrated within the abdominal cavity of dogs with SP rather than in the blood stream, a concept known as “compartmentalization.” To date, abdominal fluid NT‐proCNP concentrations have not been measured in experimental or clinical studies; however, the principle of compartmentalization for a variety of cytokines including TNF‐α, IL‐1, IL‐6, and IL‐10 has been previously described in human patients with SP 8, 9. Similarly, in a population of client‐owned dogs with SP, TNF‐α concentrations were higher in abdominal fluid than serum, suggesting the occurrence of compartmentalization in dogs 10…”