Purpose: Elevated levels of soluble tumor necrosis factor receptors (sTNF-Rs) are associated with multiple organ failure and increased mortality rates in critically ill patients. Paradoxically, experimental data suggest exogenous sTNF-Rs may improve outcome in patients who undergo elective abdominal aortic aneurysm (AAA) repair. This study examines, for the first time, changes in sTNF-R levels during repair of ruptured and nonruptured AAA.
Methods: Sixteen patients who underwent surgical procedures for ruptured AAA and 10 patients who underwent surgical procedures for nonruptured AAA were studied. Levels of sTNF-Rs p55 and p75 were measured before the operation and immediately before and 5 minutes, 6 hours, and 24 hours after aortic clamp release.
Results: When compared with nonruptured AAA, levels of sTNF-R p55 were significantly higher in ruptured AAA 5 minutes (P <.02) and 24 hours after aortic clamp release (P <.05). Levels of sTNF-R p75 were significantly higher in ruptured AAA before (P <.05), during (P <.001), and after the surgical procedure (P <.01). Six hours after aortic clamp release, sTNF-R p75 levels were significantly higher in nonsurvivors of ruptured AAA when compared with survivors (P <.05) and patients who underwent surgical procedures for nonruptured AAA (P <.01).
Conclusion: Ruptured AAA repair is associated with increased sTNF-R expression. Furthermore, elevated levels of sTNF-R p75 are associated with increased postoperative mortality rates.
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