Activation of cellular immune response in acute pancreatitis.
BACKGROUND
Inflammatory mediators have recently been implicated as potential markers of severity in acute pancreatitis.


OBJECTIVE
To determine the value of neopterin and polymorphonuclear (PMN) elastase as markers of activation of cellular immunity and as early predictors of disease severity.


METHODS
Fifty two non-consecutive patients classified according to their clinical outcome into mild (n = 26) and severe pancreatitis (n = 26).


METHODS
Neopterin in serum and the PMN elastase/A1PI complex in plasma were measured during the first three days of hospital stay.


RESULTS
Within three days after the onset of acute pancreatitis, PMN 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 with mild disease. There was a significant correlation between PMN elastase and neopterin values on days 1 and 2. PMN elastase on day 1 predicted disease severity with a sensitivity of 76.7% and a specificity of 91.6%. Neopterin did not surpass PMN elastase in the probability of predicting disease severity.


CONCLUSIONS
These data show that activation of cellular immunity is implicated in the pathogenesis of acute pancreatitis and may be a main contributory factor to disease severity. Neopterin was not superior to PMN elastase in the prediction of severity.
Mora
A
A
Department of Internal Medicine, Hospital General Universitario de Elche, Alicante, Spain.
Pérez-Mateo
M
M
Viedma
J A
JA
Carballo
F
F
Sánchez-Payá
J
J
Liras
G
G
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001708:Biopterins / Q000031:analogs & derivatives / Q000097:blood; D005260:Female; D006801:Humans; D007111:Immunity, Cellular; D019272:Leukocyte Elastase / Q000097:blood; D008297:Male; D008875:Middle Aged; D019798:Neopterin; D010195:Pancreatitis / Q000276:immunology*
D015415:Biomarkers; D001708:Biopterins; D019798:Neopterin; D019272:Leukocyte Elastase