The Decrease of Peripheral Blood CD4+ T Cells Indicates Abdominal Compartment Syndrome in Severe Acute Pancreatitis.
OBJECTIVE
Few data are available on the role of T lymphocytes and inflammatory cytokines in abdominal compartment syndrome (ACS) in severe acute pancreatitis (SAP). We conducted a retrospective study to assess the risk factors associated with ACS in SAP.


METHODS
A total of 76 SAP patients who were admitted within 24 hours after symptom onset in our study. There were 36 patients suffering from ACS and 40 from intra-abdominal hypertension (IAH). On the 1st, 3rd and 7th days after hospital admission, the following variables were assessed: serum value of C-reactive protein (CRP), and the proportions of peripheral CD4+ and CD8+ T lymphocytes. Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and computed tomography severity index (CTSI) score were assessed on days 1 and 7 after hospitalization.


RESULTS
Compared with the patients with IAH, ACS patients showed statistically higher CRP value on 7th day after hospital admission, proportions of CD4+ T cells on days 1, 3, 7 and CD4+/CD8+ ratio on day 1 were significantly lower (P < 0.05, respectively). A CD4+ T cell proportion of 30.3% on the 1st day indicated ACS with an area under the curve (AUC) of 0.774, a sensitivity with 82.5% and specificity with 72.0%, respectively. Sensitivity/specificity for predicting ACS in SAP patients on day 1 was 70.0%/68.0% for CD4+/CD8+ ratio, 72.2%/65.0% for APACHE II score.


CONCLUSIONS
The reduction of peripheral blood CD4+ T lymphocytes is associated with ACS in SAP, and may act as a potential predictor of ACS in SAP.
Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China; Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou Province, People's Republic of China.
Yao
Y
Liu
Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou Province, People's Republic of China.
Ling
L
Wang
Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou Province, People's Republic of China.
Zhifang
Z
Cai
Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou Province, People's Republic of China.
Peng
P
Zhao
Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou Province, People's Republic of China.
Cijun
C
Peng
Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou Province, People's Republic of China.
Lijin
L
Zhao
Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China.
Chidan
C
Wan
D018806:APACHE; D002097:C-Reactive Protein / Q000378:metabolism; D016516:CD4-CD8 Ratio; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D059325:Intra-Abdominal Hypertension / Q000175:diagnosis*; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000473:pathology*; D012189:Retrospective Studies
D016207:Cytokines; D002097:C-Reactive Protein