Διαφορές και ομοιότητες στην ανοσιακή απάντηση του σηπτικού ασθενούς μετά οξεία χειρουργική κοιλία συγκριτικά με το σηπτικό σύνδρομο άλλης λοιμώδους αιτιολογίας

Abstract

Former studies of our group have shown that the innate and adaptiveimmune status may differ in relation with the causative infection. To this sameend, it was investigated if kinetics of circulating lipopolysaccharide (LPS)leading to inflammatory response may differ. Blood was sampled from 189patients with sepsis and 206 with severe sepsis/shock starting 24 hours fromadvent of sepsis and repeating on day 3. Serum LPS was measured byLimulus Amebocyte Lysate (LAL) assay. From 59 patients, circulatingmonocytes were isolated and incubated in the absence/presence of LPS.Concentrations of tumour necrosis factor alpha (TNFα) were measured insupernatants by an enzyme immunoassay. In either category of severity,circulating LPS was greater among sufferers from primary Gram-negativebacteraemia (BSI) and from community-acquired pneumonia (CAP) thansufferers from other underlying infections. LPS were greater among patientswith BSI compared to patients with secondary Gram negative bacteraemia and patients without bacteraemia. Greater decrease of circulating LPS over48 hours was recorded for survivors compared to non survivors only withinsufferers from BSI and CAP. Significant endotoxemia was considered forpatients with serum LPS within the upper quartile of distribution; theirmonocytes were less potent for release of TNFα. It is concluded thatendotoxemia in sepsis varies greatly with the underlying infection; this isrelated with immunoparalysis of monocytes with implications on final outcome.