







































_____________________________________________________________________________________________________ 
 
*Corresponding author: E-mail: jehiaghe@biu.edu.ng; 
 
Cite as: F.A., Ehiaghe, Nworah, C.M., Ehiaghe, J.I., Osakue, O.N., Olisah, M.C., Ize-Iyamu, J., Amengialue, O.O., and 
Ogoegbunam, N.D. 2025. “Serum Levels of TNF- α, IL-10 and Albumin in Female Patients With Post-Surgical Wound Infection 
in Asaba Delta State, Nigeria”. Asian Journal of Immunology 8 (1):134-41. https://doi.org/10.9734/aji/2025/v8i1167. 
 

 
 

Asian Journal of Immunology 
 
Volume 8, Issue 1, Page 134-141, 2025; Article no.AJI.137461 
 

 
 

 

 

Serum Levels of TNF- α, IL-10 and 
Albumin in Female Patients with Post-

Surgical Wound Infection in Asaba 
Delta State, Nigeria 

 
Ehiaghe, F.A. a, Nworah, C.M. b, Ehiaghe, J.I. c*,  

Osakue, O.N. b, Olisah, M.C. d, Ize-Iyamu, J. e, 

Amengialue, O.O. f and Ogoegbunam, N.D. a 

 
a Department of Immunology and Immunochemistry, Nnamdi Azikiwe University, Anambra State, 

Nigeria. 
b Department of Clinical Chemistry, Nnamdi Azikiwe University, Anambra State, Nigeria. 

c Department of Medical Laboratory Science, Faculty of Allied Health Sciences, Benson Idahosa 
University, Benin City, Nigeria. 

d Department of Medical Biochemistry, Faculty of Basic Medical Sciences, Chukwuemeka Odimegwu 
Ojukwu University, Uli, Nigeria. 

e Edo State Health Management Board, Benin City, Edo State, Nigeria. 
f Department of Medical Microbiology, Wellspring University, Benin City, Edo State, Nigeria. 

 
Authors’ contributions  

 
This work was carried out in collaboration among all authors. All authors read and approved the final 

manuscript. 
 

Article Information 
 

DOI: https://doi.org/10.9734/aji/2025/v8i1167  
 

Open Peer Review History: 
This journal follows the Advanced Open Peer Review policy. Identity of the Reviewers, Editor(s) and additional Reviewers,  

peer review comments, different versions of the manuscript, comments of the editors, etc are available here: 
https://pr.sdiarticle5.com/review-history/137461  

 
 

Received: 03/04/2025 
Published: 11/06/2025 

 

Original Research Article 

https://doi.org/10.9734/aji/2025/v8i1167
https://pr.sdiarticle5.com/review-history/137461


 
 
 
 

Ehiaghe et al.; Asian J. Immunol., vol. 8, no. 1, pp. 134-141, 2025; Article no.AJI.137461 
 
 

 
135 

 

ABSTRACT 
 

Post-operative wound infections (POWIs), sometimes referred to as post-surgical wound infections 
(PSWIs), are a common complication following surgery. Surgeries frequently elicit a variety of 
immunological responses subsequent to tissue damage and incision which may hinder wound 
healing and infection resolution leading to poor patient outcome. This cross-sectional study 
assessed the serum levels of TNF-α, IL-10 and albumin in female patients with post-surgical wound 
infection in Asaba Delta State, Nigeria. Twenty-five (25) patients with PSWIs and 25 apparently 
healthy individuals (control group) were recruited by random sampling method. Four millilitres (4 ml) 
of venous blood samples were collected for the determination of serum TNF-α, IL-10 and albumin 
levels. TNF-α and IL-10 levels were estimated with a sandwich enzyme-linked immunosorbent 
assay, whereas serum albumin was assessed with the Bromocresol green (BCG) method.  The 
data obtained was analyzed using an independent t-test and Pearson correlation, with a p-value of 
<0.05 indicating statistical significance. The mean serum TNF-α (143.44 ±7.35 Vs 37.32 ±8.92; p = 
0.001) and IL-10 (27.52 ±7.77 Vs 17.12 ±6.23; p = 0.001) levels were significantly higher while 
serum albumin level was significantly lower (34.14 ±5.43 Vs 40.19 ±3.38; p = 0.001) in the female 
patients with PSWIs than in the control group. However, no significant correlation was observed 
between the levels of TNF-α Vs albumin and IL-10 Vs albumin (p>0.05). The elevated levels of pro-
inflammatory cytokine TNF-α may lead to adverse patient outcomes by hindering wound healing 
and slowing infection resolution. 
 

 
Keywords: POWIs; TNF-α; IL-10; albumin; patients. 
 

1. INTRODUCTION 
 
Post-operative wound infections (POWIs), 
sometimes referred to as postsurgical wound 
infections (PSWIs), are a common complication 
following surgery, characterized by complex and 
multifaceted pathophysiology (Zabaglo et al., 
2025). Post-operative wound infection (POWIs) 
is still a leading cause of morbidity and death for 
patients having surgery, even with improvements 
in surgical techniques and a better understanding 
of the pathophysiology of wound infection 
(Kallakuri et al., 2024). The prevalence of POWIs 
is still rising in many nations, communities, and 
hospitals, albeit it varies greatly (Ehiaghe et al., 
2025b; Kallakuri et al., 2024). 
 
Surgeries frequently elicit a variety of 
immunological responses subsequent to tissue 
damage and incision (Weledji, 2021). This 
include the secretion of cytokines, stress 
responses, and acute phase proteins, which can 
be detrimental when excessive (Chidambaran et 
al., 2024; Hsing and Wang, 2015). Cytokines 
represent a viable therapeutic target, as they 
regulate all phases of wound healing, and 
abnormalities in cytokine production can lead to 
inflammatory non-healing wounds (Wong et al., 
2025). Cytokines are soluble molecular entities 
synthesized by inflammatory cells. They can be 
broadly classified as either pro-inflammatory 
cytokines (e.g., interleukins (IL)-1, 2, 8, 12; tumor 
necrosis factor α (TNF-α), interferon γ (IFNγ), 

etc.), or anti-inflammatory cytokines e.g., 
transforming growth factor beta (TGFβ), IL-4, IL-
10, IL-13 while others, like IL-6, can be both 
(Chidambaran et al., 2024). 
 
TNF-α attracts pro-inflammatory cells including 
neutrophils, macrophages, and fibroblasts to the 
wound site, where they assist remove debris and 
pathogens (Wong et al., 2025; Jang et al., 2021), 
thereby facilitating wound healing or resolution 
under physiological state. However, exaggerated 
TNF-α responses can culminate in failed wound 
infection resolution (Choy et al., 2023; Jang et 
al., 2021). 
 
Interleukin 10 (IL-10) is an important anti-
inflammatory cytokine produced mainly by the 
CD4+ T cells although other leukocytes such as 
neutrophils, B cells, dendritic cells, natural killer 
cells, and macrophages also secret it as well 
(Sun et al., 2020). Its primary functions include 
anti-inflammatory, inhibitory, or self-regulating, as 
IL-10 appears to be a potent negative feedback 
regulator that influences inflammation 
management and resolution (Al-Qahtani et al., 
2024; Steen et al., 2020). By suppressing the 
activity of macrophages and dendritic cells, IL-10 
directly shuts down the inflammatory immune 
response (Cocea and Stoica, 2024; Saraiva et 
al., 2020; Mittal et al., 2015). It also indirectly 
does so by restricting T cell activation, 
differentiation, and effector function and 
encouraging peripheral tolerance (Saraiva et al., 



 
 
 
 

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136 

 

2020; Mittal et al., 2015).  Excessive IL-10 
production or signaling can suppress host's 
effective inflammatory responses, induce 
tolerance and immune escape, and favor 
microbial persistence, which can lead to the 
establishment of chronic or latent infections 
(Carlini et al., 2023; Rojas et al., 2017; Iyer and 
Cheng, 2012). In contrast, during acute 
infections, IL-10 limits the magnitude of the 
immune responses, preventing excessive 
inflammation and protecting tissues from 
immune-mediated damage by allowing 
inflammation resolution when the pathogen is 
cleared (Carlini et al., 2023; Rojas et al., 2017). 
 
Nutritional deficiency has been associated with 
an increased risk of wound infections (Tfaily et 
al., 2022) and serum albumin level can be used 
to determine an individual’s nutritional and 
inflammatory condition (Keller, 2019). 
Hypoalbuminemia has been identified as one of 
the risk factors for surgical site infections (SSIs) 
in surgery populations (Mostafa et al., 2024; 
Ryan et al., 2018). Hypoalbuminemia, on the 
other hand, can increase the expression of TNF-
ɑ, C-Reactive Protein (CRP) and several 
interleukins, all known to be acute-phase 
proteins that promote tissue damage (Cooper et 
al., 2004; Yildirim et al., 2004). Albumin 
influences wound healing by increasing the 
transcription of tissue-forming proteins, which in 
turn triggers the NFKB pathway and speeds up 
the healing process (Utariani et al., 2020). 
Identifying risk factors for surgical site infections 
early can improve post-operative outcomes, 
minimize re-admission rates (He et al., 2019; 
Fong et al., 2014), and reduce treatment costs by 
23.8% (Javed et al., 2019). 
 
In view of all these, it has become pertinent to 
evaluate the serum levels of TNF-α, IL-10 and 
albumin circulating among female patients with 
post-surgical wound infection in Asaba Delta 
State, Nigeria. 
 

2. MATERIALS AND METHODS 
 

2.1 Study Site 
 
The study was conducted at the Federal Medical 
Center in Asaba, Delta State, Nigeria. 
 

2.2 Study Design 
 
This cross-sectional study examined the serum 
levels of tumor necrosis factor-alpha, interleukin-

10, and albumin in female patients with post-
surgical wound infection in Asaba, Nigeria. 
 

2.3 Study Population 
 
Simple random sampling was used to select 50 
participants for the study.  The test group 
consisted of 25 female patients with post-surgical 
wound infection, while the control group included 
25 apparently healthy participants. 
 

2.4 Sample Size and Sample Size 
Calculation 

 
The sample size (N) was calculated using 
prevalence from previous studies on the 
prevalence of post-surgical wound infections 
globally which was found to be 2.5% (Mengistu 
et al., 2023) according to the sample size 
calculation formula described by Daniel and 
Cross (1999). 

 

𝑁 =
𝑍2𝑃(1 –  𝑃)

𝐷2
 

 
N  = required sample size 
Z = confidence level at 95% (standard value 

of 1.96) 
P = estimated prevalence of post-surgical 

wound infections globally which was found to 
be 2.5% (Mengistu et al., 2023). 

D = margin of error at 5% (standard value = 
0.05) 

 

𝑁 =  
1.9620.025(1 − 0.025)

0.052
 

 
3.8416 𝑋 0.025(0.975)

0.0025
 

 
N = 37 minimum sample size 
Therefore, a minimum of 50 participants was 
used for this study. 
 

2.5 Inclusion Criteria 
 
Female patients with confirmed cases of post-
surgical wound infection as well as healthy 
female participants who provided informed 
consent were included for this study. 
 

2.6 Exclusion Criteria 
 
Female patients with post-surgical wound 
infection and apparently healthy female 
individuals without post-surgical wound infection 



 
 
 
 

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137 

 

who did not give their informed consent were 
excluded from this study. 
 

2.7 Sample Collection 
 
Each participant provided five milliliters (5 ml) of 
venous blood into a plain container for cytokine 
and albumin analysis. Blood samples were 
allowed to clot before being retracted and 
centrifuged for 10 minutes at 4000 rpm.  Serum 
samples were separated and kept frozen at -
20°C until analysis. 
 

2.8 Estimation of Cytokine Levels 
 

The levels of tumor necrosis factor-alpha and 
interleukin-10 were determined using the 
sandwich enzyme-linked immunosorbent assay 
technique.  
 

2.9 Estimation of Serum Albumin 
 

This was determined using the Bromocresol 
green method (BCG), as described by Doumas 
and Watson (1971) and cited by Okpogba et al. 
(2021). 
 

2.10 Statistical Analysis 
 

The data was analyzed using SPSS 20.0 and 
represented as mean ± standard deviation. The 
independent t-test and Pearson correlation were 
employed to determine the statistical difference 
and association between variables.  A P value of 
< 0.05 was considered statistically significant. 
 

3. RESULTS 
 

The mean serum TNF-α level was significantly 
higher in the female patients with post-surgical 
wound infections than in the control group 
(143.44 ±7.35 Vs 37.32 ±8.92; p = 0.001). in like 
manner, the mean serum IL-10 level was 
significantly higher in the female patients with 
post-surgical wound infections compared to the 

control group (27.52 ±7.77 Vs 17.12 ±6.23; p = 
0.001). 
 
However, there was a statistically significant 
decrease in the mean serum albumin level 
observed in the female patients with post-
surgical wound infections than in the control 
group (34.14 ±5.43 Vs 40.19 ±3.38; p = 0.001), 
(see table 1). 
 
Furthermore, there was no significant correlation 
observed between the levels TNF-α and albumin 
(r-value = -0.154; p = 0.470) as well as between 
IL-10 and albumin levels (r-value = 0.271; p = 
0.190) in the study participants (see table 2). 
 

4. DISCUSSION 
 
The present study noted a significantly higher 
mean serum TNF-α level in the female patients 
with post-surgical wound infections than in the 
control group. Elevated TNF-α levels indicate a 
pro-inflammatory response linked to chronic 
illnesses and infections (Chen et al., 2017). This 
finding aligns with the reports of other similar 
studies (Ehiaghe et al., 2025a; Ehiaghe et al., 
2025b). Exaggerated TNF-α responses may 
culminate in failed wound infection resolution 
(Choy et al., 2023). 
 
Furthermore, the higher IL-10 level observed in 
the female patients with post-surgical wound 
infections show an attempt by the body to 
moderate the excessive inflammatory responses, 
a phenomenon commonly observed in chronic 
inflammation, where anti-inflammatory cytokines 
act to avoid tissue damage. IL-10 limits the 
magnitude of the immune responses, preventing 
excessive inflammation and protecting tissues 
from immune-mediated damage by allowing 
inflammation resolution when the pathogen is 
cleared (Carlini et al., 2023). 

 

Table 1. Levels of serum TNF-α, IL-10 and albumin circulating among female patients with 
post-surgical wound infection and apparently healthy individuals (MEAN ±SD) 

 

Parameter Group N MEAN ±SD T value P value 

TNF-α 
 
 
IL-10 
 
 
Albumin 
 

TEST 
CONTROL 
 
TEST 
CONTROL 
 
TEST 
CONTROL 

25 
25 
 
25 
25 
 
25 
25 

143.44 ±7.35 
37.32 ±8.92 
 
27.52 ±7.77 
17.12 ±6.23 
 
34.14 ±5.43 
40.19 ±3.38 

45.93 
 
 
5.22 
 
 
4.73 

0.001 
 
 
0.001 
 
 
0.001 

*Statistically significant = P<0.05; TNF-α = Tumour necrosis factor- alpha, IL-10 = Interleukin -10. 



 
 
 
 

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138 

 

Table 2. The correlation between the levels of TNF-α, IL-10 and albumin in the study  
population  

 

Parameters r-value p-value 

TNFα 
Vs Albumin  

 
-0.154 

 
0.470 

IL-10  
Vs Albumin 

0.271 0.190 

*Statistically significant at p<0.05 

 
Nevertheless, elevating IL-10 levels can provide 
some anti-inflammatory buffering, but its 
efficiency may be limited by pro-inflammatory 
cytokines like TNF-α, leading to an unsustainable 
immunological balance. Thus, increased 
inflammatory response shown in our current 
investigation may hamper infection resolution, 
eventually leading to poor treatment outcome in 
these patients. 
 
In the present study, the mean serum albumin 
level was found to be significantly lower in the 
female patients with post-surgical wound 
infection compared to the control group. This 
result agrees with several studies that found 
significantly lower serum albumin levels in 
PSWIs patients (Choudhary et al., 2024; Sultana 
et al., 2024; Llombart et al., 2023; Singh et al., 
2023; He et al., 2020). Hypoalbuminemia, an 
indicator of malnutrition and illness, has been 
shown to increase the likelihood of poor post-
operative outcomes, especially reduced wound 
healing (Sultana et al., 2024). In addition to 
increasing albumin production, inflammatory 
conditions can enhance albumin breakdown, 
which can result in hypoalbuminemia (Weaving 
et al., 2016).   Interstitial oedema results from a 
decrease in oncotic pressure caused by a 
decrease in serum albumin levels, which might 
impede the healing and recovery process. 
 

5. CONCLUSION 
 
This study found that female patients with post-
surgical wound infections had significantly higher 
mean serum TNF-α and IL-10 levels, as well as 
lower mean serum albumin levels. Findings 
presented in the study suggest that higher levels 
of the pro-inflammatory cytokine TNF 𝛼, may 
adversely impact wound healing and impede 
resolution of infection.   
 

CONSENT AND ETHICAL APPROVAL 
 
The ethical committee of the Federal Medical 
Centre in Asaba, Delta State, approved the study 

before it commenced. The informed consent of 
all involved participants was sought and gained. 
 

DISCLAIMER (ARTIFICIAL INTELLIGENCE) 
 
Author(s) hereby declare that NO generative AI 
technologies such as Large Language Models 
(ChatGPT, COPILOT, etc.) and text-to-image 
generators have been used during the writing or 
editing of this manuscript.  
 

COMPETING INTERESTS 
 
Authors have declared that no competing 
interests exist. 
 

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