Tumor necrosis factor-alpha and interleukin-1 alpha as predictors of survival in peritonitis: A pilot study

Abstract

Context: Peritonitis induces an inflammatory response characterized by the elevation of various cytokine levels. Included in this cascade of cytokines are tumor necrosis factor‑alpha (TNF‑α) and interleukin‑1 alpha (IL‑1α). The outcome of patient care may be associated with the pattern of elaboration of these cytokines.

Aim: The aim of this study was to describe the pattern of cytokine response (TNF‑α and IL‑1α) in the course of peritonitis and evaluate them as predictors of mortality in peritonitis.

Setting and Design: This was a prospective study conducted in the Division of Gastrointestinal Surgery, University College Hospital, Ibadan.

Methods: Consenting patients with clinical diagnosis of generalized peritonitis over a 6‑month period (July to December 2015) were recruited. The serum samples of these patients were obtained at presentation, immediately after surgery, and 24 h and 48 h after surgery with a follow‑up period of 30 days.

Results: Twenty‑six samples out of thirty could be analyzed. Serum TNF‑α and IL‑1α levels were both elevated at presentation in all patients. However, the patterns of change after intervention varied between the survivors and nonsurvivors.

Conclusion: Peritonitis triggers a simultaneous increase in serum levels of TNFα and IL‑1α. Lower serum level of TNF‑α is associated with survival, while on the contrary, higher level of IL‑1α is associated with survival.

Keywords: Cytokines, outcome, peritonitis