SECRETORY PHOSPHOLIPASE A(2) IN PATIENTS WITH INFECTED PANCREATIC NECROSES IN ACUTE-PANCREATITIS

Secretory synovial-type PLA(2) (sPLA(2)-II) in peripheral blood is kno wn to be associated with systemic complications in patients with sever e diseases. Being the pacemaking enzyme in eicosanoid synthesis, sPLA( 2)-II is a mediator of the inflammatory response and plays a role in h ost defense against bacterial infection. We evaluated the clinical rol e of systemic sPLA(2)-II in bacterial infection of pancreatic necroses in severe acute pancreatitis. In 58 patients with acute pancreatitis, pancreatic and sPLA(2)-I and sPLA(2)-II were measured daily for the f irst 14 days of hospital treatment by a time-resolved fluoroimmunoassa y. All 36 patients with necrotizing pancreatitis underwent regular fin e needle aspiration (FNA) to monitor bacterial infection. In 10 patien ts, infected necroses were found on FNA and postoperative examination. On admission and at most days throughout the observation period, syst emic sPLA(2)-II was significantly higher in patients with infected nec roses than in patients with sterile necroses or interstitial pancreati tis. This difference was not found for sPLA(2)-I, but values were high er in necrotizing pancreatitis than in interstitial pancreatitis at th e first 2 days of hospital treatment. If sPLA(2)-II was >300 ng/ml on 2 successive days within the first 4 days, infected necroses could be predicted with a sensitivity of 89%, a specificity of 88%, and a negat ive predictive value of 95%. Systemic sPLA(2)-II has the potential to identify patients at risk of bacterial infection of pancreatic necrose s and its routine measurement may therefore, in combination with FNA, offer a valuable tool in monitoring patients with acute necrotizing pa ncreatitis.