Plasma anti-inflammatory cytokines and monocyte human leucocyte antigen-DR expression in patients with acute pancreatitis.
BACKGROUND
Immune suppression plays a role in the pathogenesis of acute pancreatitis. The purpose was to describe plasma anti-inflammatory cytokines and blood monocyte human leucocyte antigen (HLA)-DR expression, a cellular marker of immune suppression, in relation to clinical outcome in acute pancreatitis.


METHODS
We studied 74 patients with acute pancreatitis admitted within 72 h after symptom onset; 27 had mild disease and 47 severe disease, of whom 20 developed organ failure. Plasma cytokine concentrations and monocyte HLA-DR density were determined at admission and 1, 2, 3, 7, 14 and 21 days later.


RESULTS
The levels of interleukin-1 receptor antagonist, interleukin-6 and interleukin-10 correlated inversely to monocyte HLA-DR expression; each marker correlated with disease severity. Interleukin-4, -11 and -13 levels were low. Organ failure occurred at median 36 h (range 8 to 158) after admission and was predicted at admission by the combination of interleukin-6 and interleukin-10 with sensitivity of 95%, specificity of 88% and positive likelihood ratio of 7.6 (95% confidence interval 3.3 to 17). Patients with secondary infections had a lower proportion of HLA-DR positive monocytes than did controls at day 14 (median: 32% versus 65%; n = 7) and at day 21 (median: 49% versus 83%; n = 6), P < 0.05 each. In the organ failure group, HLA-DR expression did not differ between survivors and non-survivors.


CONCLUSIONS
Determining the severity of anti-inflammatory reaction at admission and monitoring the course of immune suppression provide a means for predicting clinical outcome in acute pancreatitis.
Mentula
P
P
Dept. of Bacteriology and Immunology, Haartman Institute, Finland. panu.mentula@saunalahti.fi
Kylänpää
M L
ML
Kemppainen
E
E
Jansson
S E
SE
Sarna
S
S
Puolakkainen
P
P
Haapiainen
R
R
Repo
H
H
D000208:Acute Disease; D005260:Female; D005434:Flow Cytometry; D006684:HLA-DR Antigens / Q000097:blood*; D006801:Humans; D007378:Interleukins / Q000097:blood*; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology; D010195:Pancreatitis / Q000097:blood* / Q000150:complications / Q000276:immunology; D011379:Prognosis; D012372:ROC Curve; D012720:Severity of Illness Index
D006684:HLA-DR Antigens; D007378:Interleukins