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Cecal Ligation Puncture Procedure
Published on: May 7, 2011
Tumor necrosis factor gene polymorphism and septic shock in surgical infection
G J Tang1, S L Huang, H W Yien
1Department of Anesthesiology and Surgical Critical Care, Veterans General Hospital-Taipei, Taiwan, Republic of China.
Objectives:
To evaluate the relationship of the genotype distribution of the tumor necrosis factor (TNF)-alpha polymorphism with regard to the plasma TNF-alpha concentration and the development of septic shock as well as mortality of infected patients in a surgical intensive care unit (SICU).
Design:
A total of 112 postoperative critically ill infected patients were prospectively enrolled.
Setting:
SICU of a tertiary university-affiliated medical center.
Patients:
Patients who were consecutively admitted to the SICU because of surgical infection with sepsis.
Intervention:
Blood sampling.
Measurements And Main Results:
Blood sample was obtained 24 hrs after intensive care unit (ICU) admission or within 2 hrs after the onset of septic shock to determine the plasma TNF-alpha level and to analyze the genotype of the biallelic polymorphism of the TNF-alpha.
Results:
The allele frequency of the TNF2 in our infected ICU patients was 12%. Forty-two (37.5%) patients admitted fulfilled the criteria of septic shock during their ICU stay. Patients carrying the TNF2 allele were not more likely to develop septic shock, nor did they have a higher mortality rate. In the patients with septic shock, those carrying the TNF2 allele had a significantly higher mortality rate than those with the homozygous TNF1 genotype (92% vs. 62%, p < .05). In those who developed septic shock, the TNF2 allele was significantly associated with higher TNF levels.
Conclusion:
In patients admitted to SICU with surgical infection, the frequency of TNF2 allele was higher than in the general population. SICU patients with TNF2 allele did not show a higher incidence of developing septic shock, nor was there a higher baseline TNF-alpha level after infection. However, once septic shock had developed, the mortality rate was higher in those patients carrying the TNF2 allele.
