Cytokines, their genetic polymorphisms, and outcome after abdominal aortic aneurysm repair

Background. Excessive cytokine production has been implicated in the development of organ failure. Polymorphic sites in cytokine genes have been shown to affect levels of production in vitro and may influence cytokine production in vivo. The aims of this study were to determine if cytokines or their genetic polymorphisms were related to outcome after abdominal aortic aneurysm (AAA) repair. Methods. A prospective study of 135 patients undergoing open AAA repair. Plasma levels of TNF-alpha, IL-1beta, IL-6 and IL-10 were measured 24 h post-operatively and genotypes for the TNF-alpha -308, IL-1beta + 3953, IL-6 -174, IL-10 -1082 and IL-10 -592 polymorphisms were determined for each patient. Results. After elective AAA high levels of IL-10 were associated with both prolonged critical care (P < 0.001) and hospital stay (P = 0.001). The presence of a G allele at the IL-6 -174 locus was associated with a higher incidence of organ failure (P = 0.04) and an A allele at TNF-alpha -308 with prolonged critical care stay (P = 0.03). After ruptured AAA the development of multi-organ failure zoos associated with high levels of IL-6 (P = 0.01) and TNF-alpha (P = 0.04). High TNF-alpha levels were also associated with mortality (P = 0.01). Conclusion. Post-operative cytokine levels are related to outcome after AAA repair. Cytokine gene polymorphisms may provide a method for determining which patients are at high risk of complications.