Perioperative plasma concentrations of tumor necrosis factor-α and interleukin-6 in infected patients

Objective: To characterize the sequential plasma concentrations of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) and their relationship with the clinical outcome in patients with intra-abdominal infection who underwent surgical intervention. Design: A prospective, comparative study. Setting: Surgical intensive care unit of a university hospital. Patients: Fifteen patients with surgically proved intra-abdominal infection were included as the infected group. The comparative noninfected group consisted of ten patients who underwent major abdominal surgery without infection. Interventions: Blood samples were obtained from the indwelling arterial catheter before induction of general anesthesia, and 1, 1.5, 2, 3, 4, 6, and 24 hrs after skin incision. Measurements and Main Results: Plasma cytokine concentrations were measured using radioimmunoassay. The hemodynamic and physiologic parameters were recorded for comparison with cytokine concentrations. In the noninfected group, the TNF-α concentration was very low throughout the observation period, and the IL-6 concentration increased 4 hrs after skin incision. The infected group had significantly higher TNF- α and IL-6 concentrations than the noninfected group. The TNF-α concentration increased from 129.2 ± 46.4 to 1196.0 ± 445.8 pg/mL and the IL-6 concentration increased from 54.2 ± 24.3 to 560.3 ± 187.5 pg/mL 2 hrs after skin incision in the infected group. The postoperative APACHE II score correlated significantly with both peak IL-6 (r² = .39) and peak TNF-α (r² = .32) concentrations. Conclusions: Both TNF-α and IL-6 concentrations increased significantly after surgical intervention in patients with intra- abdominal infection. The pulse increase in TNF-α concentration and the persistent increase in IL-6 concentration were related to the poor postoperative clinical condition in infected patients.