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In cases of any acute surgical abdominal disease the progression of purulent inflammation can lead to local  or diffuse peritonitis. The indicators of the degree and specificity of the inflammatory response in blood such as cytokine  concentration, neutrophil activity, plasma antioxidant capacity (thiols concentration) could be considered  as potential predictors of complications. The luminol-dependent chemiluminescence (CL) response of blood activated  by the phorbol ester (PMA), and the concentration of cytokines IL-6, IL-8, IL-10, myeloperoxidase (MPO) and thiols  in plasma were measured in patients with uncomplicated condition (group 1, n=8), local peritonitis (group 2, n=9)  or diffuse peritonitis (group 3, n=9) at admission to surgery (before surgical operation, b/o), immediately after surgical  operation (a/o) and a day after surgery (1 day) as well as in healthy volunteers (norm, n=12). In all time-points  the cytokines and MPO concentrations measured by ELISA, in group 3 were higher than in healthy volunteers  and in patients in groups 1 and 2. Blood CL demonstrated a more than 5-fold increase above the normal values  in all patients, and was also higher in group 2 as compared to group 1 (b/o and a/o). Patients in group 3 had shown  both maximum and minimum of CL values, which could be a consequence of neutrophil priming or exhaustion  (“immune paralysis”), respectively. The same patients' plasma exhibited low thiol concentration (≤30% vs normal  values). In patients with fatal outcomes (group 3, n=2) within a day after surgery, either a decrease of the CL to zero  values concurrently with elevated IL-8 and IL-6 concentrations and low thiol levels was observed, or CL exceeded  normal values more than 20 times with concurrent complete exhaustion of the plasma thiol pool. No clear dependency  between the plasma parameters and neutrophil activity was found. Hence a parameter set for prognosis and/or  early diagnosis of infectious complications in acute abdominal pathology should include different biomarkers  of the inflammatory response: cytokine profile (IL-6, IL-8, IL-10), MPO and neutrophil activity, antioxidant plasma  capacity (e.g., total thiols concentration).

Biomarkers of system inflammation in local and diffuse peritonitis