NEOPTERIN IN ACUTE-PANCREATITIS

Background: Activation of the cellular immune system may play a role i n the pathogenesis of acute pancreatitis (AP); it has recently been pr oposed that excessive leukocyte stimulation may lead to the most sever e forms of AP. The aim of this study was to investigate serum neopteri n, a useful in vivo marker of macrophage activation, in mild and sever e AP and its relationship with other markers of leukocyte activation, such as interleukin-6 (IL-6) and tumor necrosis factor (TNF). Methods: Serum levels of neopterin (mmol/ml), n-6 (pg/ml), and TNF (pg/ml) wer e measured on the 1st and 7th day of hospitalization in 17 patients wi th severe AP and 24 with mild AP. Severe AP was defined in accordance with the Atlanta criteria: all patients have necrosis at contrast-enha nced computerized tomography scan. Results: Day 1: Neopterin and IL-6 levels were significantly higher in the severe than in the mild AP and normal controls; mild AP values were also significantly higher than i n normal controls. The best neopterin cutoff level we obtained (30 mmo l/ml) reached a specificity of 76% and a sensitivity of 46% in disting uishing severe from mild AP. Day 7: Neopterin was significantly higher in severe PLP than in-mild AP and in normal controls; no difference w as seen between mild AP values and normal controls; neopterin serum le vels were significantly higher on day 7 than on day 1 in severe AP but not in mild AP; in both groups of patients IL-6 was significantly hig her on day 1 than on day 7. Using a neopterin cutoff level of 40 mmol/ ml, we found a specificity and sensitivity value of 92% in differentia ting severe from mild AP. With regard to TNF values, no difference was seen on days 1 and 7 in the two groups of patients in comparison with normal controls. Neopterin serum values did not correlate with IL-6 a nd TNF on either day. Conclusions: These results confirm the activatio n of the cellular immune system in AP. Initially enhanced NEOP and IL- 6 serum levels reflect the severity of the disease; neopterin may be c onsidered a reliable prognostic indicator also at a distance from AP o nset because its levels increase during the Ist week of AP in patients with severe forms only.