BACKGROUND: An excessive leucocyte activation takes place early in severe acute pancreatitis. Furthermore, some indirect evidences suggest a disturbance of the mononuclear phagocytic system in the severe cases. AIMS: To compare the early functionalism of leucocytes obtained from patients with mild disease and severe disease, under the hypothesis that an impaired phagocytic function could be associated with the leucocyte activation. PATIENTS AND METHODS: Flow cytometric parameters of leucocyte function, such as phagocytosis, and fluorescence of leucocytes with acridine orange (FLAO) were prospectively measured together with granulocyte elastase plasma concentrations in 21 patients with severe (n = 7) and mild (n = 14) acute pancreatitis. Samples were drawn at 24 hours from admission, 48 hours, 72 hours, and on day 5. RESULTS: There was a greater leucocyte activation together with a deficient phagocytosis before 72 hours in severe patients. The results (mean (SEM)) severe v mild were: 440 (115) microgram/l v 77 (14) micrograms/l for granulocyte elastase, 2.218 (377) v 1.308 (155) for FLAO, 64 (7) v 90 (2), and 55 (9) v 81 (3) for percentages of phagocytising neutrophils and monocytes, respectively. Phagocytic capacity returned to normal later on day 5. CONCLUSIONS: The excessive leucocyte activation together with the impaired phagocytosis could be related to the onset of complications in severe acute pancreatitis.
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