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Titolo:
The value of immune modulating parameters in predicting the progression from peritonitis to septic shock
Autore:
Katja, B; Hartmut, K; Pawel, M; Stefan, B; Kox, WJ; Spies, CD;
Indirizzi:
Free Univ Berlin, Benjamin Franklin Med Ctr, Dept Anesthesiol & Intens Care Med, D-1000 Berlin, Germany Free Univ Berlin Berlin Germany D-1000 Care Med, D-1000 Berlin, Germany Humboldt Univ, Charite, Med Ctr, Dept Anesthesiol & Intens Care Med, D-1086 Berlin, Germany Humboldt Univ Berlin Germany D-1086 ens Care Med, D-1086 Berlin, Germany
Titolo Testata:
SHOCK
fascicolo: 2, volume: 15, anno: 2001,
pagine: 95 - 100
SICI:
1073-2322(200102)15:2<95:TVOIMP>2.0.ZU;2-R
Fonte:
ISI
Lingua:
ENG
Soggetto:
INFLAMMATORY RESPONSE SYNDROME; DYSFUNCTION SYNDROME MODS; MULTIPLE-ORGAN FAILURE; NECROSIS-FACTOR-ALPHA; CRITICALLY-ILL; INTRAABDOMINAL INFECTION; SECONDARY PERITONITIS; ADHESION MOLECULES; TNF-RECEPTORS; NITRIC-OXIDE;
Keywords:
severe infection; intra-abdominal sepsis; predictors; tumor-necrosis factor-alpha; critically ill patients;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
35
Recensione:
Indirizzi per estratti:
Indirizzo: Spies, CD Univ Klinikum Berlin, Charite, Klin Anaesthesiol & Operat Intensivmed, Campus Mitte,Schumannstr 20-21, D-10117 Berlin, Germany Univ Klinikum Berlin Campus Mitte,Schumannstr 20-21 Berlin Germany D-10117
Citazione:
B. Katja et al., "The value of immune modulating parameters in predicting the progression from peritonitis to septic shock", SHOCK, 15(2), 2001, pp. 95-100

Abstract

Intra-abdominal infection is one of the major causes of septic shock and multiple organ failure. To date, what causes the disease's progression remains unclear and therefore the relevance of immune modulating therapies remains speculative. The primary outcome measure of this study was to investigate immune modulating mediators at the onset of peritonitis before the development of subsequent septic shock. The secondary outcome measure was to investigate the usefulness of these immune parameters in predicting progressionfrom peritonitis to septic shock. Fifty-eight peritonitis patients were included in this study: 14 patients subsequently developed septic shock. All patients were examined on "diagnosis of peritonitis" (<4 h within establishment of diagnosis), during "early septic shock" (<12 h following the onset of septic shock), and once again during "late septic shock" ( within 72-98 h following the onset of septic shock). The immune modulating parameters tumor necrosis factor-alpha (TNF-alpha), the soluble TNF-alpha receptors I and II (sTNF-alpha RI and sTNF-alpha RII), interleukines (IL) -1 beta, -6, -8, and -10, and the adhesions molecules endothelial-leukocyte-adhesion-molecule (E-Selectin), intercellular-adhesion-molecule-1(ICAM-1) and vascular-adhesion-molecule-1 (VCAM-1), in addition to nitrate and nitrite, were determined. In the peritonitis group with subsequent septic shock, TNF-alpha, sTNF-alpha RI + RII IL-l beta, IL-8, IL-10, and nitrate were significantly increased before the onset of septic shock. TNF-alpha had an area under the receiver operating characteristics curve (AUC) of 0.84 and was reliable in predicting the progression from peritonitis to septic shock. The AUC of the other immune modulating parameters, despite being significantly elevated, ranged from 0.71 to 0.76. The AUC of the conventional laboratory markers suchas leukocytes and C-reactive protein ranged from 0.64 to 0.68, In peritonitis that progressed to septic shock, an early immune response had already occurred before the onset of septic shock. The progression was best predicted by TNF-alpha. Therefore, mediator therapy might be considered in high-risk peritonitis patients who show an exaggerated immune response before the progression to septic shock.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 19/01/20 alle ore 00:29:36