Selected interleukins, soluble TNF-α receptors, c-reactive protein and cortisol as biomarkers of surgical trauma-induced inflammation in children

PURPOSE: To evaluate the influence of surgical trauma-induced inflammation and surgery type or presence of appendicitis on the levels of the studied cytokines, CRP and cortisol as biomarkers. METHODS: A prospective study was performed of pediatric patients undergoing laparotomy or laparoscopy. The concentrations of cytokines were assessed using Luminex xMAP technology, CRP by immunoturbidimetric method, and cortisol by ELISA. Their levels were determined twice at four time points: at baseline, after 6-12 h postoperative (cortisol), 12-24 h (other markers apart from CRP), and 36-48 h (CRP). RESULTS: Significant increases were observed in IL-6 (p = 0.001) and IL-10 (p = 0.034) in non-inflammatory patients undergoing laparotomy, and in IL-6 in inflammatory (p = 0.035) and non-inflammatory (p < 0.001) groups receiving laparoscopy. Significant increases in IL-8 (p = 0.020) and sTNFRII (p = 0.004) were demonstrated in patients with inflammation undergoing laparoscopy. Significant increased CRP levels were noted in all four examined subgroups (p = 0.003, p = 0.01, p < 0.001, p < 0.001). CONCLUSION: sTNFRII, CRP and IL-6 are sensitive biomarkers of surgical trauma-induced inflammation. sTNFRII and CRP are reliable indicators of the presence of appendicitis. Laparotomy resulted in a greater increase in sTNFRII levels, whereas laparoscopy stimulated CRP production more strongly. The open surgery is characterized by earlier mechanical tissue injury than laparoscopy.