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СRITERIA FOR ASSESSING ENDOGENOUS INTOXICATION IN PATIENTS WITH MULTIPLE PERITONITIS

Valeriy V Boyko¹, Viktor M Likhman², Oleksandr M Shevchenko³

¹SI «ZAYCEV V. T. INSTITUTE OF GENERAL AND URGENT SURGERY OF NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE», KHARKIV, UKRAINE; KHARKIV NATIONAL MEDICAL UNIVERSITY, KHARKIV, UKRAINE.

Wiadomosci Lekarskie (Warsaw, Poland : 1960)

|February 1, 2023

Abstract

Objective:

The aim: To determine the diagnostic significance of the level of malondialdehyde (MDA) in various biological media for RP for assessing and predicting the course of the disease.

Patients And Methods:

Materials and methods: Our study included The work was based on the results of surgical treatment of 60 patients with RP: according to MPI I - in 17 (28.3%), MPI II - in 23 (38.4%) and MPI III - in 20 (33.3%) patients. Surgical intervention for RP was aimed at sanitation and drainage of the abdominal cavity. The control group included 15 practi¬cally healthy people, whose blood and urine biochemical parameters served as the norm. According to the clinical course of the disease, the patients were divided depend on admission, The secondary product of lipid peroxidation - MDA was studied in blood serum, peritoneal exudate and urine in patients with RP, depending on the severity of the pathological process according to the Mannheim peritoneal index (MPI) - I severity (I), II severity (II), III severity (III). The work was based on the results of surgical treatment of 60 patients with RP: according to MPI I - in 17 (28.3%), MPI II - in 23 (38.4%) and MPI III - in 20 (33.3%) patients.

Results:

Results: Analyses of results showed that the average value of MDA in various biomedicals of recovered (n = 18) and subsequently died (n = 5) patients with MPI II are given in Table. 2. As can be seen from the presented data, the average value of MDA in blood serum and peritoneal exudate in patients with a lethal outcome is significantly higher than in those who have recovered. This fact indicates a more pronounced endogenous intoxication in patients who died from RP.

Conclusion:

Conclusions: The content of MDA in the blood serum before surgery in patients with a lethal outcome was 190% (p <0.001). The level of MDA in urine in patients according to MPI II who subsequently died before surgery was 110% (p <0.001), and in those who recovered by 300% (p <0.001) it was higher than the norm. exudate taken during the operation averaged 4.14 ± 0.33 nmol / ml, then in the recovered - 2.89 ± 0.08 nmol / ml. A high level of MDA in the blood serum, peritoneal exudate with a decrease in the elimination of MDA in the urine in the postoperative period are prognostically unfavorable signs in patients, indicating the continuation of endogenous intoxication and a possible death.

Insights

Elevated malondialdehyde (MDA) levels in blood serum and peritoneal fluid indicate higher endogenous intoxication and a poorer prognosis in patients with generalized peritonitis (RP). Monitoring MDA is crucial for predicting outcomes.

Area of Science:

Biochemistry
Surgical Pathology
Clinical Diagnostics

Background:

Generalized peritonitis (RP) is a severe condition often associated with significant morbidity and mortality.
Endogenous intoxication, a state of systemic toxicity due to the body's own metabolic byproducts, plays a critical role in RP progression.
Malondialdehyde (MDA), a secondary product of lipid peroxidation, serves as a marker for oxidative stress and cellular damage.

Purpose of the Study:

To evaluate the diagnostic and prognostic value of malondialdehyde (MDA) levels in various biological media for patients with generalized peritonitis (RP).
To assess the correlation between MDA levels and the severity of RP, as classified by the Mannheim Peritoneal Index (MPI).
To determine if MDA levels can predict disease course and patient outcomes, including mortality.

Main Methods:

The study analyzed surgical treatment data from 60 patients with RP, categorized by MPI severity (I, II, III).
MDA levels were measured in blood serum, peritoneal exudate, and urine.
A control group of 15 healthy individuals provided baseline biochemical parameters.

Main Results:

Patients with a lethal outcome exhibited significantly higher average MDA levels in blood serum and peritoneal exudate compared to recovered patients.
Pre-operative MDA levels in non-survivors were substantially elevated (190% in blood serum, 110% in urine) compared to the norm.
Recovered patients showed significantly higher MDA levels in urine (300%) compared to the norm, suggesting altered elimination pathways.

Conclusions:

Elevated MDA in blood serum and peritoneal exudate, coupled with reduced urinary MDA excretion post-surgery, are unfavorable prognostic indicators in RP.
These findings suggest persistent endogenous intoxication and an increased risk of mortality in such patients.
MDA measurement holds diagnostic significance for assessing RP severity and predicting patient prognosis.

Read full analysis

Keywords:

generalized peritonitis inflammation endogenous intoxication malondialdehyde (MDA)

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