title: Elevation of serum interleukin-6 concentration precedes acute-phase response and reflects severity in acute pancreatitis.
abstract: Experimental studies have shown that interleukin-6 induces all major acute-phase proteins in the liver, including C-reactive protein. In 50 patients with acute pancreatitis, the serum concentrations of interleukin-6 and C-reactive protein were determined daily during the first week of hospitalization. Patients were divided into three groups according to clinical criteria: mild pancreatitis (less than or equal to 1 complication; n = 25), severe pancreatitis (greater than or equal to 2 complications; n = 15), and lethal outcome (n = 10). Patients with mild disease showed initially slightly elevated levels of interleukin-6 (22.0 +/- 9.8 U/mL) that decreased to low levels within 4 days (5.0 +/- 1.0 U/mL). In patients with severe pancreatitis, serum concentrations of interleukin-6 were initially clearly elevated (35.0 +/- 7.5 U/mL) and remained slightly elevated until day 7 (13.0 +/- 2.0 U/mL). Patients with lethal outcome had markedly elevated initial interleukin-6 concentrations (61.0 +/- 15.0 U/mL) that decreased but were still elevated at day 7 (26.0 +/- 2.5 U/mL). In all three groups, C-reactive protein concentrations followed the course of interleukin-6 concentrations by 1 day. There was a positive correlation between maximal interleukin 6 concentrations and maximal increases in the serum concentrations of C-reactive protein (r = 0.66). At days 1 and 2, increased (greater than 15 U/mL) interleukin-6 concentrations (positive predictive value, 91%; negative predictive value, 82%) predicted a severe or lethal course of the disease more accurately than elevated [greater than 0.10 g/L (greater than 10 mg/dL)] C-reactive protein concentrations (positive predictive value, 67%; negative predictive value, 79%). In conclusion, elevated serum concentrations of interleukin-6 followed by increased levels of C-reactive protein reflect the severity of acute pancreatitis.
authors.affiliation: Department of Internal Medicine, University of Freiburg, Germany.
authors.forename: H G
authors.initials: HG
authors.lastname: Leser
authors.forename: V
authors.initials: V
authors.lastname: Gross
authors.forename: C
authors.initials: C
authors.lastname: Scheibenbogen
authors.forename: A
authors.initials: A
authors.lastname: Heinisch
authors.forename: R
authors.initials: R
authors.lastname: Salm
authors.forename: M
authors.initials: M
authors.lastname: Lausen
authors.forename: K
authors.initials: K
authors.lastname: Rückauer
authors.forename: R
authors.initials: R
authors.lastname: Andreesen
authors.forename: E H
authors.initials: EH
authors.lastname: Farthmann
authors.forename: J
authors.initials: J
authors.lastname: Schölmerich
mesh_terms: D000208:Acute Disease; D000210:Acute-Phase Reaction / Q000209:etiology*; D002097:C-Reactive Protein / Q000032:analysis; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D010195:Pancreatitis / Q000097:blood* / Q000150:complications / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D013997:Time Factors
chemical_list: D015850:Interleukin-6; D002097:C-Reactive Protein