The evaluation of immunoinflammatory response in acute bacterial peritonitis

AIM: To evaluate the immunoinflammatory markers that shape the evolution of acute peritonitis and to assess their utility in specifying the development of septic shock from peritonitis. MATERIAL AND METHOD: We conducted a prospective study on a sample of 100 patients with acute peritonitis, hospitalized during 2001-2005 and immunologically monitored. We realized 2000 dosages of immunoinflammatory markers for 15 days by 1200 simple radial immunodiffusion tests (IDRS), the Mancini-Carbonara method for C reactive protein, complement component C3, immunoglobulins and 836 ELISA tests to evaluate cytokines. Results were reported to a witness group. RESULTS: C reactive protein (CRP) values were significantly elevated in patients with peritonitis (12-310 ng%) vs. witness group (1.5-8 ng%). Postoperative, elevated values were maintained at the patients who will develop serious complications and were correlated with multiple organic dysfunction in deceased patients. Determination of circulating immune complexes have shown elevated values in patients with peritonitis. Dosage of pro/antiinflammatory cytokines may be specific to the severity of inflammatory response to infection. The level of procalcitonin was increased in patients with sepsis and severe inflammatory reactions and become an important prognostic tool. CONCLUSIONS: The study of biological markers in microbial aggression highlights the role of cytokines as messengers and important mediators of immunoinflammatory response. PCT test can be introduced in the daily tracking protocol for septic patients.