The state of the immune system in abdominal sepsis.

AIM: To evaluate the prognostic value of cytokine profile, phagocytosis activity indices, endotoxin concentration and activity in blood in gram-negative sepsis. MATERIALS AND METHODS: 78 patients with abdominal sepsis were included in a one-center prospective cohort study, of them 45 died. All the patients were evaluated for the concentration of circulating cytokines (TNF-α, IFN-γ, IL-6, IL-8, IL-10), cellular molecules (CD3, CD45RO, CD95 and HLA-DR), bactericidal and phagocytic activity of neutrophils and endotoxin (lipopolysaccharide) level in peripheral blood. RESULTS: The concentrations of all cytokines were slightly lower in the survivors. Significant differences were noted for TNF-α (p=0.001), IL-6 (p=0.001), and IL-8 (p=0.007). The expression of HLA-DR molecules was slightly higher (p=0.055), and CD95 was lower (p=0.146) in survivors than in the dead. However, the differences have not reached the required level of statistical significance. The phagocytic (p<0.001) and bactericidal activity (р=0.002 for stimulated activity and p=0.001 for spontaneous activity) of neutrophils is significantly different. In survived patients, we noted large values of stimulated bactericidal activity and phagocytic index than the dead. Level of spontaneous activity in survivors was lower. In subsequently deceased patients, the level of endotoxin load was higher than in the surviving patients: level of lipopolysaccharide concentration (p=0.002), endotoxin activity (p=0.032) and neutrophils activity (p=0.028). CONCLUSION: Evaluation of cytokine levels is informative, but due to the high spread of indicators in different patients, should be carried out in the dynamics. The most informative prognostic parameters in sepsis are the concentration and activity of lipopolysaccharides (endotoxin), phagocytic and bactericidal activity of neutrophils. The EAA (endotoxin activity assay) assessment should be conducted in conjunction with the neutrophil "response" assessment.

[Effectiveness of hemofiltration in patients with peritonitis and acute respiratory distress syndrome].

The subjects of the study were 149 patients with severe pyo-septic complications of abdominal diseases, resulting in multiple organ failure syndrome (MOFS) with clinical and laboratory manifestations. Acute respiratory distress syndrome (ARDS) as a component of MOFS was diagnosed in 39 (26.2%) patients. The complex treatment included hemofiltration in a volume of at least 25 liters. The study shows that hemofiltration is an effective and pathogenetic method of complex treatment of MOFS, which has a positive effect on the main pathogenetic mechanisms in ARDS, thus allowing improvement of oxygen transport in blood. Hemofiltration improves central hemodynamics as well as blood circulation in the lungs and peripheral tissues in patients with MOFS and ARDS; it allows correction of volemic and metabolic disorders, and endogenous intoxication reduction. The use of hemofiltration in ARDS led to a 2-fold lethality reduction.

[Continuous low-flow vein-vein hemofiltration in peritonitis: changes in the severity of endotoxicosis as a criterion for the efficiency of the technique].

The efficiency of intermittent and continuous hemofiltration was comparatively evaluated in the complex treatment of 27 patients having multiple organ dysfunction along with pyoseptic complications of abdominal diseases. Based on the study of a broad spectrum of markers of toxicosis and the severity of organ dysfunction, it was concluded that the efficiency of the procedure should be objectively evaluated to optimize the time of its performance.

[Integrated hemodynamic response to hemofiltration and peritoneal dialysis in patients with acute renal failure]. / Integrirovannyi gemodinamicheskii otvet na gemofil'tratsiiu i peritoneal'nyi dializ u bol'nykh s ostroi pochechnoi nedostatochnost'iu.

Central hemodynamics was studied by integral polyrheography in 24 patients with acute renal failure (ARF) during hemofiltration (HF) and in 18 patients with ARF during peritoneal dialysis. All central hemodynamic parameters improved by the end of HF. However stroke volume decreased by 26.6%, stroke index by 24.4%, minute volume by 25.7%, and cardiac index by 24.8% as early as at the moment of extracorporeal contour filling. This was paralleled by an increase of total peripheral vascular resistance from 1321 +/- 124 to 1586 +/- 106 din/(cm*c-5) (by 16.7%). Hence, clear-cut signs of centralization of circulation were seen during the initial period of HF in patients with ARF. Peritoneal dialysis did not lead to centralization of circulation in patients with ARF; moreover, minute heart volume increased by 9% during some stages of the procedure, stroke volume increased significantly (p < 0.05), other parameters increased, but total peripheral vascular resistance was virtually unchanged. After removal of dialysis solution from the abdominal cavity all hemodynamic parameters returned to the initial values. Hence, both hemofiltration and peritoneal dialysis ameliorate the central hemodynamics. However peritoneal dialysis does not involve even temporary centralization of circulation, which has a positive impact on the course of acute tubular necrosis.

[Selective detoxication of the portal vein blood in toxic hepatopathy in patients with peritonitis]. / Selektivnaia detoksikatsiia krovi iz vorotnoi veny pri toksicheskoi gepatopatii u bol'nykh peritonitom.

Selective detoxication of the blood from the portal vein was carried out in 31 patients with peritonitis complicated by multiple organ dysfunction including toxic hepatopathy. Selective extracorporeal detoxication of the blood from the portal vein possesses notable regional hemodynamic advantages in comparison with other variants of vascular approaches and essentially improves the transhepatic bloodflow. The authors emphasize that bifiltration cascade exchange portoplasmapheresis is a method of choice in severe toxic hepatopathy in patients with peritonitis. They recommend alternating bifiltration cascade exchange portoplasmapheresis with portohemofiltration in patients with toxic hepatonephropathy.