Local and systemic innate immune response to secondary human peritonitis. Influence of micro-organism.

Abstract : INTRODUCTION: Our aim was to describe inflammatory cytokines response in the peritoneum and plasma of patients with peritonitis. We also tested the hypothesis that scenarios associated with worse outcome would result in different cytokine release patterns. Therefore, we compared cytokine responses according to the occurrence of septic shock, mortality, type of peritonitis and peritoneal microbiology. METHODS: Peritoneal and plasma cytokines (IL-1, tumour necrosis factor alpha [TNFalpha], IL-6, IL-10, and IFN) were measured in 66 patients with secondary peritonitis. RESULTS: The concentration ratio between peritoneal fluid and plasma cytokines varied from 5 [2 - 21] (IFN) to 1310 [145 - 3888] (IL-1). There was no correlation between plasma and peritoneal fluid concentration of any cytokine. In the plasma, TNFalpha, IL-6, IFN, and IL-10 were higher in patients with shock versus no shock, and in nonsurvivors versus survivors (p[less than or equal to]0.03). There was no differential plasma release for any cytokine between community-acquired and postoperative peritonitis. Presence of anaerobes or Enterococcus specie in peritoneal fluid was associated with higher plasma TNFalpha: 50 [37-106] vs 38 [29-66] and 45 [36 - 87] vs 39 [27 - 67] pg/ml, respectively (p=0.02). In the peritoneal compartment, occurrence of shock did not result in any difference in peritoneal cytokines. Peritoneal IL-10 was higher in patients who survived (1505 [450 to 3130] vs 102 [9 to 710] pg/ml; p=0.04). Presence of anaerobes and Enterococcus specie was associated with higher peritoneal IFN: 2 [1-6] vs 10 [5-28] and 7 [2-39] vs 2 [1-6], p=0.01 and 0.05 respectively). CONCLUSIONS: Peritonitis triggers an acute systemic and peritoneal innate immune response with a simultaneous release of pro and anti-inflammatory cytokines. Greater levels of all cytokines were observed in the plasma of patients with the most severe conditions (shock, non survivors), but this difference was not reflected in their peritoneal fluid. There was always a large gradient in cytokine concentration between peritoneal and plasma compartments highlighting the importance of compartmentalization of innate immune response in peritonitis.
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Critical Care, BioMed Central, 2013, 17 (5), pp.R201. 〈10.1186/cc12895〉
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Florence Riché, Etienne Gayat, Corinne Collet, Joaquim Matéo, Marie-Josèphe Laisné, et al.. Local and systemic innate immune response to secondary human peritonitis. Influence of micro-organism.. Critical Care, BioMed Central, 2013, 17 (5), pp.R201. 〈10.1186/cc12895〉. 〈inserm-00879186〉

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