Determination of the impact of pneumoperitoneum on sepsis severity in an animal model of peritonitis through C-reactive protein and procalcitonin serum levels assessment

Abstract number: P1927

Chatzimavroudis G., Kontopoulou K., Pavlidis T., Orfanou A., Stergiou I., Afkou Z., Atmatzidis S., Atmatzidis K.

Objectives: C-reactive protein (CRP) and procalcitonin (PCT) consist two substantial inflammator markers. The aim of this study was to evaluate the effect of CO2 pneumoperitoneum, induced for different exposure times, on sepsis cascade through determination of CRP and PCT serum levels.

Methods: In 30 New Zealand rabbits, peritonitis was induced by the cecumligation and puncture (CLP)model. After 12 hours, animals were randomised in 7 groups: group 1; control group, groups 2, 3, 4 and 5; pneumoperitoneum of 10–15 mmHg for 60–180 minutes, groups 6 and 7; laparotomy for 60 and 180 minutes, respectively. Blood samples were collected before CLP, 12 later and 1, 3 and 6 hours after pneumoperitoneum desufflation or abdominal trauma closure to evaluate bacteraemia, C-reactive protein (CRP) and procalcitonin (PCT) levels. Furthermore, 2-day mortality was recorded in all animals. For the assessment of CRP and PCT, 2 ml of blood were collected in pyrogen-free tubes (Vacutainer, Becton Dickinson, Cockeysville, MD) and centrifuged. The serum was kept refrigerated at -70°C until assayed. Serum levels of CRP were quantitatively determined using an automated immunoturbidimetric assay (Hitachi 912, ROCHE, Basel, Switzerland), with the detection limit of the assay being 0.5 mg/dl.PCT was measured using a commercial immunoluminometric assay (B.R.A.H.M.S. Diagnostics GmbH, Berlin, Germany)which uses two antibodies that bind to two sites (calcitonin and katakalcin)of the procalcitonin molecule, thus ruling out cross-reactivity. The detection limit of the assay is 0.5 ng/ml.

Results: Bacteraemia was induced in all groups. Moreover, in all groups significant increases of CRP and PCT levels were measured at 12 hours following peritonitis induction, with respect to baseline values (p < 0.05). Subsequent measurements showed even higher levels of CRP and PCT in all groups. No differences were recorded among groups in association to CRP levels at all time intervals. However, serum PCT reached statistically higher levels (p < 0.05) in groups with laparotomy compared to groups with pneumoperitoneum and control group at 6 hours. Survival was lower in groups with laparotomy than in groups with pneumoperitoneum and control group (p < 0.05).

Conclusion: In the presence of peritonitis, CO2 pneumoperitoneum applied in usual in clinical practi-ce pressures, even for extended time intervals, attenuates the severity of sepsis and increases survival.