title: Inflammatory response in the early prediction of severity in human acute pancreatitis.
abstract: The role of the inflammatory response in acute pancreatitis and its relation with the clinical course was examined. This study examined if the serial measurement of polymorphonuclear granulocyte (PMN) elastase/A1PI complex, phospholipase A catalytic activity, C reactive protein, and other acute phase proteins, and the protease inhibitor alpha 2-macroglobulin, provides meaningful information for prognosis. Eighty non-consecutive patients with acute pancreatitis, classified according to their clinical outcome into mild (n = 40) and severe pancreatitis (n = 40), were followed up daily. Between 48 hours, median values of PMN-elastase, C reactive protein--and most of the acute phase proteins--and phospholipase A activity, were significantly higher in the severe pancreatitis group. PMN elastase shows a dynamic course and it reaches an early peak value at days 1-2, followed by C reactive protein (days 2-4) phospholipase A (day 3), and a negative peak for alpha 2-macroglobulin (days 4-5). PMN elastase (day 1) and C reactive protein (day 2) were selected by discriminant analysis as the most useful variables studied to allow the early accurate prediction of severity (sensitivity 100%, specificity 95%). Little or no predictive additional value was found for all other variables studied. These results strongly suggest a close relation between inflammatory parameters and clinical course in acute pancreatitis, and discriminant analysis of these variables provides a useful method to classify severity.
authors.affiliation: Department of Clinical Chemistry, Elche General Hospital, University of Alicante, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Viedma
authors.forename: M
authors.initials: M
authors.lastname: Pérez-Mateo
authors.forename: J
authors.initials: J
authors.lastname: Agulló
authors.forename: J E
authors.initials: JE
authors.lastname: Domínguez
authors.forename: F
authors.initials: F
authors.lastname: Carballo
mesh_terms: D000208:Acute Disease; D000209:Acute-Phase Proteins / Q000032:analysis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D016002:Discriminant Analysis; D005260:Female; D006801:Humans; D019272:Leukocyte Elastase; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009504:Neutrophils / Q000201:enzymology; D010196:Pancreatic Elastase / Q000032:analysis; D010195:Pancreatitis / Q000097:blood*; D010741:Phospholipases A / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D013997:Time Factors; D000515:alpha 1-Antitrypsin / Q000032:analysis
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D000515:alpha 1-Antitrypsin; C037741:alpha 1-antitrypsin-leukocyte elastase complex; D010741:Phospholipases A; D010196:Pancreatic Elastase; D019272:Leukocyte Elastase