Proinflammatory cytokines in early assessment of the prognosis of acute pancreatitis

Objective: Proinflammatory cytokines are involved in the pathogenesis of ac ute pancreatitis. The value of serum levels of tumor necrosis factor-alpha, interleukin-1-beta, interleukin-6, and interleukin-8 in predicting the out come of acute pancreatitis was evaluated. Methods: In 50 patients with acut e pancreatitis, the serum concentrations of tumor necrosis factor-a, interl eukin-1-beta, interleukin-6, interleukin-8, and C-reactive protein were det ermined on days 1, 2, 3, 4, and 7 after admission. Acute Physiology and Chr onic Health Evaluation (APACHE LI) scores were recorded on days 1, 2, and 3 . Results: Serum concentrations of interleukin-1-beta, interleukin-6, inter leukin-8, and C-reactive protein on days 1-7 were significantly higher in p atients with severe pancreatitis than in patients with mild pancreatitis. P atients with severe attacks had significantly elevated serum tumor necrosis factor-alpha concentrations on days 1-3 compared with those with mild atta cks, but not on days 4 and 7. The median peak value of tumor necrosis facto r-cy, interleukin-1-beta, interleukin-6, and interleukin-8 was reached on d ay 1, in contrast to the median peak of C-reactive protein, which was reach ed on day 2. Using cutoff levels of 12 pg/ml for tumor necrosis factor-alph a, 1 pg/ml for interleukin-l-P, 400 pg/ml for interleukin-6, 100 pg/ml for interleukin-8, 12 mg/dl for C-reactive protein and 10 for the Acute Physiol ogy and Chronic Health Evaluation (APACHE II) score, the accuracy rates for detecting severe pancreatitis were 72%, 82%, 88%, 73%, 80%, and 72%, respe ctively, on day 1 and 78%, 74%, 80%, 76%, 80%, and 78%, respectively, on da y 2. Conclusion: Among the proinflammatory cytokines, interleukin-6 is the most useful parameter for early prediction of the prognosis of acute pancre atitis. (C) 1999 by Am. Coll. of Gastroenterology.