SERUM CONCENTRATIONS OF INFLAMMATORY MEDIATORS RELATED TO ORGAN FAILURE IN PATIENTS WITH ACUTE-PANCREATITIS

Leucocyte activation and proinflammatory cytokine release (tumour necr osis factor (TNF) and interleukin 6 (IL-6)) are thought to contribute to the induction of a systemic inflammatory response, an acute-phase r esponse and multiple organ failure in patients with acute pancreatitis , The serum concentration of TNF, soluble TNF receptors (sTNFR(55) and sTNFR(75)), IL-6 and C-reative protein (CRP) in 58 patients with acut e pancreatitis was assessed during the first 2 days of admission. Thir ty patients had mild disease and 28 severe disease, of whom 18 develop ed local pancreatic complications alone (Atlanta classification) and t en developed organ failure (a Goris score of 1 or more). TNF was detec ted in only 17 patients on the first day of admission, while soluble T NF receptors were detected in all patients and IL-6 in 34. On the firs t and second days of admission there was a progressive and significant (P<0.03) increase in the median concentration of sTNFR(55), sTNFR(75) and IL-6 in patients eventually classified into those with mild disea se, a local pancreatic complication alone, or organ failure. This patt ern was also evident in CRP levels from the second but not the first d ay of admission, These findings suggest that proinflammatory cytokines or their soluble receptors may be more accurate early predictors of o utcome than CRP. Moreover, markers of inflammation in the sera of pati ents with acute pancreatitis are highest in those who subsequently dev elop organ failure.