DIAGNOSTIC CRITERIA OF ABDOMINAL SEPSIS IN PATIENTS WITH POSTOPERATIVE PERITONITIS CAUSED BY FAILURE OF THE GASTROINTESTINAL TRACT SUTURES
Authors: Droniak M. M. , Droniak V. M. 
Published: January 2023

The aim is to study changes in nonspecific resistance and cytokine regulation in patients with postoperative peritonitis with abdominal sepsis.

Materials and methods. In the Ivano-Frankivsk Regional Clinical Hospital of the Ivano-Frankivsk Regional Council hospital in the surgery department 456 patients were treated with postoperative peritonitis during 2000 -2021. Immunological studies were conducted in 66 patients with various degrees of severity of abdominal sepsis and its complications.

Research results. In patients with abdominal sepsis with postoperative peritonitis caused by the failure of sutures of the gastrointestinal tract, the initial level of CD11a+ is 1.6 times lower than that of control group patients. On the first day after relaparotomy, the level of CD11a+ cells in the blood increased by 1.8 times. On the 7th day of the postoperative period, this indicator corresponded to the control one.

The initial level of CD16+ cells in the blood, as well as their content on the first day of the postoperative period, did not differ significantly from the control indicators. However, on the seventh day after the operation, this indicator was twice as high as in the control group. In patients with abdominal sepsis with postoperative peritonitis during the entire observation period, the expression of HLA-DR+ molecules on immunocompetent cells did not differ from that in the control group.

Violation of immune recognition mechanisms was confirmed by the low expression level of HLA-DR+ molecules on immunocompetent cells, which practically did not change in the postoperative period and was twice as low as in the control group during all observation periods.

The initial level of IL-2 was equal to the control group. On the first day after the operation, the concentration of IL-2 in the blood decreased by half, compared to the control level. On the seventh day after the operation, a further decrease in the concentration of IL-2 in the blood was observed by 2.2 times compared to the control level.

The concentration of IL-4 in the plasma of patients with abdominal sepsis with postoperative peritonitis caused by the failure of the sutures of the gastrointestinal tract, who died in the postoperative period, was not determined during the entire observation period.

The plasma content of IL-6 at the initial level was 1.7 times higher than that of the control group. This indicator was twice the control level after relaparotomy. By the seventh day of the postoperative period, its increase in 4.5 times compared to practically healthy individuals.

Thus, the failure of sutures is accompanied by an imbalance of cytokine regulation of the immune response: a permanent decrease in the plasma concentration of IL-2, against the background of the absence of IL-4 in the blood, is combined with a progressive increase in the content of IL-6 in the blood, which creates an additional cytokine signal of suppression of the immune response. Such changes are regarded as an inadequate reaction of the immune system to a potential infection of the abdominal cavity.

Conclusions. These changes in non-specific resistance and cytokine regulation, in particular such indicators as CD11a, CD162, CD95, CD16, HLA-DR+, IL-2, IL-4, IL-6 showed their high diagnostic informativ and sensitivity in predicting the development of abdominal sepsis in patients with postoperative peritonitis caused by failure of sutures of the gastrointestinal tract.