CLINICAL RELEVANCE OF CYTOKINES IL-6, IL- 8, AND C-REACTIVE PROTEIN IN THE BLOOD OF PATIENTS WITH ACUTE-PANCREATITIS

The detection of cytokines may elucidate the pathophysiological mechan isms that produce early systemic complications in acute interstitial ( i) or necrotizing (n) pancreatitis (AP). The increase in the level of cytokines in the blood of patients with AP may correlate with the seve rity of the disease. In a prospective clinical trial from October 1992 to August 1993, 23 patients with AP were recruited and blood samples taken for cytokine detection by commercially available Elisa kits and C-reactive protein (CRP) by laser nephelometry. Six of 11 patients wit h nAP died either early (n = 1) or of late septic complications. None died of iAP. The peak of cytokine and CRP level in the first 3 days of hospitalization was used for calculation. The IL-6 concentration in t he blood reached up to 2600 pg/ml in the Ist few days, depending on th e severity of AP, and dropped to almost zero in the next days, indepen dently of the clinical course. The differentiation of i- versus nAP, u sing a cutoff line of 600 pg/ml, was correct in 20 patients [87 %, sen sitivity (SE): 82 %, specificity (SP): 91 %, P < 0.001]. The blood lev els of IL-8 reached a maximum of 1381 pg/ml in the Ist few days, depen ding on the severity of AP, and showed a correlation with the clinical course in the following days. The peak of IL-8 blood levels indicated correctly the severity of AP in 18 out of 23 patients using a cutoff level of 200 pg/ml (accuracy: 78 %, SE: 82 %, SP: 75 %, P < 0.01). The CRP levels increased up to a maximum of 535 mg/l and indicated the co urse of AP correctly in 18 out of 22 patients (SE and SP 82 %, P < 0.0 1). There was no correlation between cytokine blood levels and mortali ty. In the blood samples of five patients with i- or nAP, no TNF-alpha was detectable. The blood levels of IL-6, and to a lesser extent of I L-8 and CRP, can predict the severity and early systemic complications of AP. The excessive rise in cytokines can be explained by the stimul ation of immunological cells (macrophages, lymphocytes and endothelial cells) in the course of AP, inducing early systemic complications.