Relation of serial measurements of plasma-soluble intercellular adhesion molecule-1 to severity of acute pancreatitis

OBJECTIVE: Acute pancreatitis remains a clinical challenge because it is di fficult to predict whether, in a given patient, the disease will be mild or will run a severe course with a possibly fatal outcome. The aim of this st udy was to investigate whether circulating soluble intercellular adhesion m olecule-1 (sICAM-1) as a marker of leukocyte activation is related to the s everity of the disease. METHODS: The study included 29 consecutive adults admitted with acute pancr eatitis. Plasma sICAM-1 levels were measured serially over a period of 6 da ys, and values and time courses were correlated with clinical severity. RESULTS: Our patients fell into four groups on the basis of the following m easurements: 1) Decreasing sICAM-1 levels with maximal values of 446 +/- 90 ng/ml (mean +/- SEM) slightly above the upper limit of normal were associa ted with uncomplicated mild disease in seven patients. 2) In nine patients with sICAM-1 concentrations reaching a peak of 743 +/- 121 ng/ml after 3 da ys, severe pancreatitis was present in 11% and pancreatic necrosis occurred in 33%. 3) A second increase of sICAM-1 (maximal level: 993 +/- 169 ng/ml) after an initial decrease (relapsing pattern, 7 patients) was associated w ith a severe course of disease in 71% including pancreatic necrosis in 43% and nosocomial pneumonia in 42%. 4) A rapid increase of sICAM-1 reaching hi ghest maximal values of 1738 +/- 104 ng/ml (p < 0.0001) indicated fulminant pancreatic necrosis and a fatal outcome in six patients. CONCLUSIONS: Serial plasma sICAM-1 levels in patients with acute pancreatit is within the first 6 days after admission fall into four different groups of severity according to the shape of the curves. This suggests that the ti me course of elevated plasma sICAM-1 concentrations reflects the risk of de veloping necrosis and clinical complications in acute pancreatitis. (Am J G astroenterol 1999;94:2412-2416 (C) 1999 by Am. Cell. of Gastroenterology).