CIRCULATING MEDIATORS IN ACUTE-PANCREATITIS AS PREDICTORS OF SEVERITY

The case mortality for acute pancreatitis in the UK has remained large ly unchanged, at just under 10% for the last 30 years. This is despite improvements in intensive therapy, radiology and surgical interventio ns. Acute pancreatitis also remains unpredictable. Organ system failur e and pancreatic collections may develop either suddenly, or insidious ly, and thus go undetected. Reducing mortality depends on better under standing of pathophysiology and more specific therapeutic approaches, but prognostic systems for the early identification of severe attacks may improve the success of current supportive therapies. Prognostic sy stems are also useful to compare clinical series and stratify severity in therapeutic trials. The multiple criteria of Ranson and Imrie pred ominate, but offer limited accuracy, involve delay, are cumbersome, an d provide a one-off overall prediction. Internationally agreed definit ions of complications demand accurate risk assessment for individual c omplications, while serial monitoring of severity is needed to assess progress and to detect subtle changes after therapeutic intervention. Laboratory methods now provide equal, or improved, accuracy and speed compared to traditional criteria, and may be repeated serially. Growin g knowledge of the systemic inflammatory response syndrome (SIRS) and the availability of response modifiers suggests that inflammatory medi ators may prove to be the most useful and accurate means of assessment of severity.