INCREASED PLASMA-CONCENTRATIONS OF CIRCULATING INTERCELLULAR-ADHESIONMOLECULE-1 (CICAM-1) IN PATIENTS WITH NECROTIZING PANCREATITIS

The intercellular adhesion molecule-1 (ICAM-1), a membrane glycoprotei n, is important in the adhesion of cytokine-stimulated leukocytes to t he endothelium of microvessels and their transendothelial migration. C irculating isoforms of ICAM-1 (cICAM-1) are known to be elevated in hu man serum as an indirect consequence of inflammatory responses. The ai m of this study was to investigate whether cICAM-1 levels are elevated in patients with acute pancreatitis within 48 h of the onset of abdom inal pain and whether cICAM-1 levels correlate with the severity of th e tissue damage. Twenty-five consecutive patients admitted to a medica l ICU had elevated cCAM-1 concentrations of 548 +/- 68 ng/ mi, signifi cantly different when compared to a control group of 18 healthy subjec ts (343 +/- 29; p = 0.018). According to the findings of contrast-enha nced CT or laparotomy patients were further divided in a group with ac ute edematous pancreatitis and a group with acute necrotizing pancreat itis. Pancreatic necrosis was associated with cICAM-1 levels of 729 +/ - 106 ng/ml, significantly different from patients with mild disease ( 367 +/- 48) and controls (p < 0.001). Plasma cICAM-1 levels were not s ignificantly different between healthy subjects and patients with mild pancreatitis. A significant correlation was found between cICAM-1 and C-reactive protein, an acute phase reactant and marker of necrotizing pancreatitis (r = 0.62; p < 0.01). The sensitivity and specificity fo r the detection of edematous or necrotizing pancreatitis of cICAM-1 pl asma concentrations (cutoff point at 500 ng/ml) were 75 % and 85 %, re spectively. These results suggest an enhanced release of ICAM-1 into p lasma in the early stage of acute necrotizing pancreatitis. Leukocyte- endothelial cell adhesion may be associated with the inflammatory proc ess of necrotizing tissue damage in acute pancreatitis. It could thus serve as a marker or predictor of a severe clinical course of pancreat itis.