title: Relation of serial measurements of plasma-soluble intercellular adhesion molecule-1 to severity of acute pancreatitis.
abstract: OBJECTIVE
  Acute pancreatitis remains a clinical challenge because it is difficult to predict whether, in a given patient, the disease will be mild or will run a severe course with a possibly fatal outcome. The aim of this study was to investigate whether circulating soluble intercellular adhesion molecule-1 (sICAM-1) as a marker of leukocyte activation is related to the severity of the disease.
  
  
  METHODS
  The study included 29 consecutive adults admitted with acute pancreatitis. Plasma sICAM-1 levels were measured serially over a period of 6 days, and values and time courses were correlated with clinical severity.
  
  
  RESULTS
  Our patients fell into four groups on the basis of the following measurements: 1) Decreasing sICAM- levels with maximal values of 446 +/- 90 ng/ml (mean +/- SEM) slightly above the upper limit of normal were associated with uncomplicated mild disease in seven patients. 2) In nine patients with sICAM-1 concentrations reaching a peak of 743 +/- 121 ng/ml after 3 days, severe pancreatitis was present in 11% and pancreatic necrosis occurred in 33%. 3) A second increase of sICAM-1 (maximal level: 993 +/- 169 ng/ml) after an initial decrease (relapsing pattern, 7 patients) was associated with a severe course of disease in 71% including pancreatic necrosis in 43% and nosocomial pneumonia in 42%. 4) A rapid increase of sICAM-1 reaching highest maximal values of 1738 +/- 104 ng/ml (p < 0.0001) indicated fulminant pancreatic necrosis and a fatal outcome in six patients.
  
  
  CONCLUSIONS
  Serial plasma sICAM-1 levels in patients with acute pancreatitis within the first 6 days after admission fall into four different groups of severity according to the shape of the curves. This suggests that the time course of elevated plasma sICAM-1 concentrations reflects the risk of developing necrosis and clinical complications in acute pancreatitis.
authors.affiliation: Department of Internal Medicine, Karl-Franzens University, Graz, Austria.
authors.forename: P
authors.initials: P
authors.lastname: Kaufmann
authors.forename: K H
authors.initials: KH
authors.lastname: Smolle
authors.forename: G A
authors.initials: GA
authors.lastname: Brunner
authors.forename: U
authors.initials: U
authors.lastname: Demel
authors.forename: G P
authors.initials: GP
authors.lastname: Tilz
authors.forename: G J
authors.initials: GJ
authors.lastname: Krejs
mesh_terms: D000208:Acute Disease; D005260:Female; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood*; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D018799:Intercellular Adhesion Molecule-1