ACTIVATION OF CELLULAR IMMUNE-RESPONSE IN ACUTE-PANCREATITIS

Background-Inflammatory mediators have recently been implicated as pot ential markers of severity in acute pancreatitis. Aims-To determine th e value of neopterin and polymorphonuclear (PMN) elastase as markers o f activation of cellular immunity and as early predictors of disease s everity. Patients-Fifty two non-consecutive patients classified accord ing to their clinical outcome into mild (n = 26) and severe pancreatit is (n = 26). Methods-Neopterin in serum and the PMN elastase/A1PI comp lex in plasma were measured during the first three days of hospital st ay. Results-Within three days after the onset of acute pancreatitis, P MN elastase was significantly higher in the severe pancreatitis group. Patients with severe disease also showed significantly higher values of neopterin on days 1 and 2 but not on day 3 compared with patients w ith mild disease. There was a significant correlation between PMN elas tase and neopterin values on days 1 and 2. PMN elastase on day 1 predi cted disease severity with a sensitivity of 76.7% and a specificity of 91.6%. Neopterin did not surpass PMN elastase in the probability of p redicting disease severity. Conclusions-These data show that activatio n of cellular immunity is implicated in the pathogenesis of acute panc reatitis and may be a main contributory factor to disease severity. Ne opterin was not superior to PMN elastase in the prediction of severity .