Severe acute pancreatitis causes alterations in HLA-DR and CD14 expressionon peripheral blood monocytes independently of surgical treatment

Objective: To find out if the severity of acute pancreatitis or the surgica l treatment of severe acute pancreatitis influences HLA-DR and CD14 express ion on peripheral blood monocytes. Design: Prospective open study. Setting: University hospital, Austria. Subjects: 9 consecutive patients with severe acute pancreatitis in need of operative treatment, 5 patients with mild acute pancreatitis, and 7 healthy volunteers. Interventions: Samples of 5 ml blood were taken daily into endotoxin free t ubes at same time points. Surgical treatment for severe acute pancreatitis consisted of blunt necrosectomy, operative lavage, laparostomy, and open dr ainage. Main outcome measures: Correlation between HLA-DR and CD14 expression on pe ripheral blood monocytes on the one hand and the severity of acute pancreat itis and operative treatment of severe acute pancreatitis, on the other. Results: In patients with severe acute pancreatitis expression of HLA-DR an d CD14 was significantly downregulated both before and after operation (p < 0.0001; ANOVA), compared with patients with mild acute pancreatitis or hea lthy controls. However the expression of the two cell surface markers was n ot affected either by the first operation, or by the reoperations. Conclusion: These findings suggest that in acute pancreatitis the expressio n of cell surface markers on peripheral blood monocytes is related to the s everity of disease but is not influenced by operative treatment.