VALUE OF EARLY BLOOD TH-1 CYTOKINE DETERMINATION IN PREDICTING SEVERITY OF ACUTE-PANCREATITIS

Background: Early evaluation of the severity of acute pancreatitis (AP ) requires measurement of many variables within 48 h after admission. Septic complications (SC) are frequent, and preliminary studies have h ighlighted the value of prophylactic antibiotherapy; however, single a nd reliable predictive markers of sepsis are not yet available. The ai m of this study was to assess the value of determining early blood Th- l cytokines and their natural antagonists (interleukin-6 (IL-6), IL-1, IL-1ra, and the soluble form of tumor necrosis factor (sTNF) receptor s RI and RII) to predict the severity and SC during AP. Methods: Thirt y-seven patients with AP were prospectively included; 25 of them had s evere AP, including 8 with SC. Serum cytokines were measured 48 h and 72 h after the onset of AP with an enzyme-linked immunosorbent assay. The optimal severity or SC diagnostic thresholds was determined using receiver operative curves. Results: Severe AP in accordance with the A tlanta criteria were better predicted by C-reactive protein and IL-6 s erum determination, albeit these levels could not predict absolutely t he death of two patients. In severe AP cases (n = 25) the IL-l to IL-l -ra ratio was lower in cases further complicated by sepsis ((6 +/- 4) 10(-3) versus (34 +/- 13) 10(-3), P < 0.05); moreover, sTNF RI (2497 /- 270 pg/ml versus 2133 +/- 611 pg/ml, P < 0.05) and RII (3751 +/- 40 0 pg/ml versus 3045 +/- 509 pg/ml, P < 0.05) were higher in AP charact erized by further SC. The IL-I to IL-l-ra ratio and IL-1 concentration were dramatically decreased within the first 48 h ((0.4 +/- 0.4) 10(- 3) versus (30 +/- 11) 10(-3), P < 0.05, and 0.3 +/- 0.3 versus 15 +/- 3 ng/l, P < 0.05) in patients with further infection of the pancreatic necrosis (n = 3). The SC diagnosis was better anticipated by an IL-1 to IL-l-ra ratio lower than 5 x 10(-3) or by an sTNF RI higher than 17 50 pg/ml and sTNF RII higher than 2750 pg/ml, and the infection of the pancreatic necrosis by an IL-1 concentration <2 ng/l or an IL-1 to IL -l-ra ratio <2 x 10(-3). Conclusion: Besides severity markers, IL-1, I L-l-ra, and sTNF RI and RII should be considered in base-line AP assay s and, if confirmed by larger studies, could help to screen patients a t risk for SC and candidates for prophylactic antibiotherapy with a go od negative predictive value.