Immunological Predictors Of Complicated Postopera-Tive Course In Diffuse Peritonitis

Abstract

Objectives. To identify immunological predictors of complicated postoperative course in patients with diffuse peritonitis (DP) and to assess their prognostic value in the early postoperative period.

Methods. A total of 58 patients undergoing emergency surgery for DP were in-cluded. Based on postoperative outcomes, patients were stratified into two groups: complicated course (n=38) and uncomplicated course (n=20). On postoperative day 1, immune monitoring included cellular immunity (CD3⁺, CD4⁺, CD8⁺, NK cells), humoral immunity (IgA, IgM, IgG, circulating immune complexes [CIC], and the IgA×IgM/IgG index), and cytokine profile (IL-6, IL-10, TNF-α, IFN-γ). Multivariable logistic regression with Firth’s correction and ROC analysis were ap-plied to identify independent predictors of adverse outcomes.

Results. Complicated course was observed in 65.5% of patients; mortality reached 24.1% and occurred exclusively in this group. Patients with complications demon-strated significant reductions in CD4⁺ T-helper cells (25.3±4.5% vs. 34.1±4.7% without complications; p<0.05), NK cells (8.9±2.1% vs. 13.2±2.3%; p<0.05), se-rum IgM (0.83±0.17 g/L vs. 1.05±0.21 g/L; p<0.05), and the IgA×IgM/IgG index (0.11±0.02 vs. 0.16±0.02; p<0.05). These changes were accompanied by elevated IL-6 (79.4±19.7 pg/mL vs. 35.8±11.2 pg/mL; p<0.01), IL-10 and TNF-α levels. Multivariable analysis identified IL-6 >60 pg/mL (OR 4.72; 95% CI 1.61–13.84; p=0.005), CD4⁺ <30% (OR 3.42; 95% CI 1.28–9.16; p=0.015), NK cells <10% (OR 2.87; 95% CI 1.05–7.83; p=0.041), IgM <0.9 g/L (OR 2.64; 95% CI 1.01–6.94; p=0.048), and IgA×IgM/IgG index <0.12 (OR 3.95; 95% CI 1.36–11.44; p=0.011) as independent predictors. The ROC curve yielded an AUC of 0.87 (95% CI 0.78–0.96), with sensitivity of 82% and specificity of 80%.

Conclusions. The combination of hypercytokinemia and immunosuppression rep-resents a major determinant of complicated postoperative outcomes in DP. Early immune monitoring (IL-6, IL-10, CD4⁺ T-cells, NK cells, IgM, and the IgA×IgM/IgG index) provides reliable risk stratification and may guide preventive strategies. Consideration of environmental and occupational factors influencing immune competence further enhances the prognostic value and highlights the in-terdisciplinary relevance of immune assessment in abdominal sepsis.