Systemic Endotoxin and Gastric Mucosal pH Are the Best Parameters to Predict Lethal Outcome in a Porcine Model of Abdominal Sepsis According to Multivariate Analysis

This study was devised to identify sepsis-relevant parameters that early and reliably predict a lethal outcome in intra-abdominal sepsis. In 18 Duroc pigs, peritonitis was induced through standardized gastrotomy. Twelve hours later the defect was oversewn and the abdominal cavity lavaged thoroughly. Sepsis relevant parameters were measured before initiating therapy, and 30 min later animals were extubated and observed for a period of 6 days under adequate analgesia with free access to water and food. All parameters were correlated with survival postoperatively. In the treatment group, 7 out of 18 pigs (39%) died within the observation period. Endotoxin level at 30 min after initiation of therapy [17.9 EU/mL ( - 12.1) vs. 110.9 EU/mL ( - 21); p < .001] and j pHi [0.015 ( - 0.011) vs. m 0.039 ( - 0.013); p = .016] were identified as the two parameters with highest predictive power regarding mortality in a multivariate analysis. In conclusion measurement of endotoxin and gastric tonometry should gain wider clinical application in septic patients.

[1]  T. Pappas,et al.  Laparoscopic repair for perforated peptic ulcer. , 2002, Annals of surgery.

[2]  E. Ruokonen,et al.  Gastric mucosal systemic partial pressure of carbon dioxide (PCO2) gradient in experimental endotoxin shock in swine – comparison of two methods , 2001, Intensive Care Medicine.

[3]  J. Takala,et al.  Pre-operative tonometry is predictive for mortality and morbidity in high-risk surgical patients , 2000, Intensive Care Medicine.

[4]  T. Staudinger,et al.  Cytokine profile and correlation to the APACHE III and MPM II scores in patients with sepsis. , 1997, American journal of respiratory and critical care medicine.

[5]  T. Buckley,et al.  Gastric tonometry and prediction of outcome in the critically ill#Arterial to intramucosal pH gradient and carbon dioxide gradient , 1997, Anaesthesia.

[6]  I. Jousela,et al.  Validation of air tonometric measurement of gastric regional concentrations of CO2 in critically ill septic patients , 1997, Intensive Care Medicine.

[7]  J H Siegel,et al.  "Sepsis/SIRS," physiologic classification, severity stratification, relation to cytokine elaboration and outcome prediction in posttrauma critical illness. , 1996, The Journal of trauma.

[8]  S. Pastores,et al.  Splanchnic ischemia and gut mucosal injury in sepsis and the multiple organ dysfunction syndrome. , 1996, The American journal of gastroenterology.

[9]  R. Ivatury,et al.  A prospective randomized study of end points of resuscitation after major trauma: global oxygen transport indices versus organ-specific gastric mucosal pH. , 1996, Journal of the American College of Surgeons.

[10]  J. Lowes,et al.  The systemic inflammatory response syndrome as a predictor of bacteraemia and outcome from sepsis. , 1996, QJM : monthly journal of the Association of Physicians.

[11]  G. Ramsay,et al.  Natural cytokine antagonists and endogenous antiendotoxin core antibodies in sepsis syndrome. The Sepsis Intervention Group. , 1995, JAMA.

[12]  J. Wilkinson,et al.  Comparison of gastric intramucosal pH and standard perfusional measurements in pediatric septic shock. , 1995, Chest.

[13]  D. J.SchröderM.,et al.  Pattern of soluble TNF receptors I and II in sepsis , 1995, Infection.

[14]  F. Cerra,et al.  Multiple organ failure syndrome in the 1990s. Systemic inflammatory response and organ dysfunction. , 1994, JAMA.

[15]  R. Bone,et al.  Plasma Cytokine and Endotoxin Levels Correlate with Survival in Patients with the Sepsis Syndrome , 1993, Annals of Internal Medicine.

[16]  R. Bone.  Guidelines for the Use of Innovative Therapies in Sepsis , 1993 .

[17]  R. Bleichrodt,et al.  Selective decontamination of the digestive tract prevents secondary infection of the abdominal cavity, and endotoxemia and mortality in sterile peritonitis in laboratory rats , 1992, Critical care medicine.

[18]  E. Deitch,et al.  Multiple organ failure. Pathophysiology and potential future therapy. , 1992, Annals of surgery.

[19]  T. Calandra,et al.  High circulating levels of interleukin-6 in patients with septic shock: evolution during sepsis, prognostic value, and interplay with other cytokines. The Swiss-Dutch J5 Immunoglobulin Study Group. , 1991, The American journal of medicine.

[20]  U. Haglund,et al.  Tissue oxygenation in hemorrhagic shock measured as transcutaneous oxygen tension, subcutaneous oxygen tension, and gastrointestinal intramucosal pH in pigs , 1991, Critical care medicine.

[21]  M. Fink,et al.  Validation of tonometric measurement of gut intramural pH during endotoxemia and mesenteric occlusion in pigs. , 1990, The American journal of physiology.

[22]  U. Haglund,et al.  Early detection of gastrointestinal mucosal ischemia in porcine E. coli sepsis. , 1990, Acta chirurgica Scandinavica.

[23]  R. Beart,et al.  Multiple organ failure. , 1977, Surgery, gynecology & obstetrics.

[24]  A. Baue.  Multiple, progressive, or sequential systems failure. A syndrome of the 1970s. , 1975, Archives of surgery.

[25]  THE MANAGEMENT OF PEPTIC ULCER , 1945 .

[26]  W. Kern,et al.  Soluble tumor necrosis factor receptors in febrile neutropenic cancer patients , 2005, Infection.

[27]  M. Antonelli,et al.  High IL-6 serum levels are associated with septic shock and mortality in septic patients with severe leukopenia due to hematological malignancies. , 1995, Scandinavian journal of infectious diseases.