SIGNIFICANCE OF CIRCULATING CYSTEINE-DEPENDENT ASPARTATE-DIRECTED PROTEASE-1 (CASPASE-1) IN PERITONITIS

"Sepsis is considered the leading cause of death in emergency units. It is known that there are already serum immune parameters/biomarkers useful in predicting the progression from peritonitis to sepsis, respectively septic shock. In the present study, we aimed to measure the serum concentrations of CASP1, CRP and cytokines (IL-23, IL-1β, IL-18); to compare immune-inflammatory cell ratios at the onset of peritonitis, before and after sepsis; to identify correlations between the concentration of the CASP1, IL-23, IL-1β, IL-18, CRP, ESR and the indices that assess the prognosis of patients with peritonitis (MPI) and the severity of sepsis (SOFA, APACHE II) and with different ratios of immunocytes (NLR, MLR, PltLR) and to investigate the usefulness of these immune parameters in predicting the progression from peritonitis to sepsis using the area under the ROC curve. Serum samples were collected from 20 peritonitis patients diagnosed and 14 patients who developed secondary sepsis to peritonitis. For the evaluation of serum concentrations of studied mediators, we used immunoenzymatic technique. In our study, we obtained significantly increased values in the serum of patients who developed sepsis vs the group with peritonitis, for CASP1, CRP and cytokines (IL-23, IL-1β, IL-18). Serum levels of CASP1 correlated much better with the evaluated indices, statistically significant correlations. Two markers investigated, CASP1 and IL-23, had a diagnostic accuracy (71.10% and 70.90%, respectively) almost similar to the performance of IL-1β (accuracy of 71.40%), in the diagnosis of peritonitis. In conclusion, the investigated serological markers (CASP1, IL-23, IL-1β, IL-18) can be used as an independent prognostic markers for differentiation of patients with peritonitis from those with sepsis, in combination with CRP, ESR, NLR and the indices (MPI, SOFA, APACHE II)."