IMMUNE PARALYSIS IN ACUTE-PANCREATITIS - HLA-DR ANTIGEN EXPRESSION ONMONOCYTES CD14(+)DR(+)

Determination of the prognosis in acute cases of pancreatitis, particu larly in its serious and necrotizing form, still presents problems. Pa tients require intensive care and suffer from severe septic complicati ons that do not correlate with pancreatic enzyme levels (amylase lipas e). Method. Thirty-one patients with acute pancreatitis were examined: group 1 - necrotizing pancreatitis (lethal outcome n=7); group 2 - ne crotizing pancreatitis (surviving n=12); group 3 edematous pancreatiti s (surviving n=12). For 11 consecutive days after admission to a clini cal ward, flow cytometric check-ups were carried out daily on all pati ents. The antigen-presenting system HLA-DR antigen expression on monoc ytes and C-reactive protein were examined. Results. When groups 1 and 2 were compared with group 3, HLA-DR values on monocytes were signific antly different following the third day after admission (P<0.01). Comp arison of groups 1 and 2 were significant from the third day of observ ation (P<0.001). During all 11 days of observation, patients in group 1 remained in immune paralysis (HLA-DR expression on monocytes CD 14+D R+20% antigen density). All of these patients had infected necroses. P atients in group 2 overcame their immune paralysis. HLA-DR depression of monocytes and a long-standing high C-reactive protein level are alm ost certain predictors of a fatal outcome in cases with severe pancrea titis. A routine passage cytometric check/FACS to determine the activi ty of monocytes (HLA-DR) is of prognostic significance.