• R Függer, E Zadrobilek, P Götzinger, S Klimann, M Rogy, S Winkler, H Andel, M Mittelböck, E Roth, and F Schulz.
• First Surgical Department and Intensive Care, University of Vienna, School of Medicine, Austria.
• Eur J Surg. 1993 Oct 1; 159 (10): 525-9.

ObjectiveTo find out if concentrations of tumour necrosis factor a (TNF alpha) and interleukin-6 (IL-6) play a part in the pathophysiology of intra-abdominal infection, and try to identify patients who would benefit from immunotherapy against TNF alpha.DesignProspective open study.SettingUniversity hospital.Subjects19 consecutive patients (septic shock, n = 4; sepsis syndrome, n = 6; and no sepsis syndrome, n = 9, classified by the APACHE II score and the criteria of the Methyl-prednisolone Severe Sepsis Study Group) who were to undergo their first operation for intra-abdominal infection.Main Outcome MeasuresCorrelation between median (interquartile) concentrations of TNF alpha and IL-6 (pg/ml), and APACHE II score, plasma lactate concentration, and organ function.ResultsPerioperative concentrations of both TNF alpha (p = 0.001) and IL-6 (p = 0.006) were significantly higher in patients with septic shock. Preoperative cardiovascular and respiratory failure were associated with significantly raised TNF alpha (p < 0.001 in both cases) and IL-6 concentrations (p = 0.02 and p < 0.001, respectively). The preoperative APACHE II score correlated with the increased TNF alpha concentration (r = 0.5, p < 0.001) and plasma lactate concentration with that of IL-6 (r = 0.7, p = 0.003).ConclusionPerioperative TNF alpha and IL-6 concentrations correlated with the severity of intra-abdominal infection, so it is possible that patients who present with either septic shock or the sepsis syndrome may benefit from immunotherapy against TNF alpha.

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