RT Journal Article
SR Electronic
T1 Inflammatory mediators in human acute pancreatitis: clinical and pathophysiological implications
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP 546
OP 552
DO 10.1136/gut.47.4.546
VO 47
IS 4
A1 J Mayer
A1 B Rau
A1 F Gansauge
A1 H G Beger
YR 2000
UL http://gut.bmj.com/content/47/4/546.abstract
AB BACKGROUND The time course and relationship between circulating and local cytokine concentrations, pancreatic inflammation, and organ dysfunction in acute pancreatitis are largely unknown.PATIENTS AND METHODS In a prospective clinical study, we measured the proinflammatory cytokines interleukin (IL)-1β, IL-6 and IL-8, the anti-inflammatory cytokine IL-10, interleukin 1β receptor antagonist (IL-1RA), and the soluble IL-2 receptor (sIL-2R), and correlated our findings with organ and systemic complications in acute pancreatitis. In 51 patients with acute pancreatitis admitted within 72 hours after the onset of symptoms, these parameters were measured daily for seven days. In addition, 33 aspirates from ascites and the lesser sac were measured.RESULTS Sixteen patients had mild acute pancreatitis (AP) and 35 severe AP (Atlanta classification); 18 patients developed systemic complications requiring treatment. All mediators were increased in AP. sIL-2R, IL-10, and IL-6 were significantly elevated in patients with distant organ failure. An imbalance in IL-1β/IL-1RA was found in severe AP and pulmonary failure. Peak serum sIL-2R predicted lethal outcome and IL-1RA was an early marker of severity. IL-6 was the best prognostic parameter for pulmonary failure.CONCLUSION Our results suggest that local mediator release, with a probable IL-1β-IL-1RA imbalance in severe cases, is followed by the systemic appearance of pro- and anti-inflammatory mediators. The pattern of local and systemic mediators in complicated AP suggests a role for systemic lymphocyte activation (triggered by local release of mediators) in distant organ complications in severe AP.ILinterleukinIL-1RAinterleukin 1β receptor antagonistsIL-2Rsoluble interleukin 2 receptorAPacute pancreatitisMAPmild APSAPsevere APTNF-αtumour necrosis factor αSIRSsystemic inflammatory response syndromeCRPC reactive proteinLRlikelihood ratioERCPendoscopic retrograde cholangiopancreatography