Objective
To study the pattern of intraperitoneal cytokine release in secondary peritonitis and its correlation with plasma levels and prognosis.
Design
Noncomparative descriptive case series.
Setting
Department of surgery in a university hospital.
Patients
Seventeen consecutive patients undergoing planned relaparotomy for severe intra-abdominal infection (Acute Physiological and Chronic Health Evaluation [APACHE II] score >10; mean score, 17.5).
Interventions
The following were measured at the first and last serial operations in the peritoneal exudate and plasma: endotoxin, tumor necrosis factor 
(TNF-), interleukin-1 (IL-1), interleukin-6 (IL-6), elastase, and neopterin.
Main Outcome Measures
Survival and death.
Results
Six patients died. Peritoneal endotoxin levels were significantly higher than in the plasma and were significantly higher in the nonsurvivors. Plasma TNF-, IL-6, elastase, and neopterin levels remained elevated in the nonsurvivors prior to death. Levels of TNF-, IL-6, elastase, and endotoxin were 19, 993, 239, and 7 times higher, respectively, in the peritoneal exudate than in plasma, all significant differences. Elastase and TNF- levels decreased in survivors during the operative treatment but remained elevated in the nonsurvivors.
Conclusions
Secondary peritonitis is associated with a significant cytokine-mediated inflammatory response that is compartmentalized in the peritoneal cavity and indicates an adverse prognosis. Levels of cytokines in the exudate of peritonitis may be used to better stratify the severity of peritonitis and, in future, to guide local therapy.
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