Systemic inflammatory response syndrome as a severity predictor in acute pancreatitis (original) (raw)
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Frontiers in physiology, 2018
Acute pancreatitis (AP) is a painful and potentially life-threatening disorder with the potential for therapeutic interventions. Biomarkers that characterize cases by severity and pathogenic mechanisms involved are not yet available but needed for the implementation of rational therapies. Here, we used shotgun proteomics to obtain information from plasma samples about local and systemic pathologies taking place during cases of alcoholic AP. Plasma was obtained at Kaunas University of Medicine Hospital (Lithuania) from 12 AP patients of alcohol related etiology (median age of 40) within 24 h of presentation, and 12 age-matched, healthy controls. Patients entered into the study had moderately severe AP with the following characteristics: mean blood lactate dehydrogenase level of 1127 mg/dl; median APACHEII score of 5.5 and mean IMRIE score of 3.5. For proteomic analysis, less-abundant proteins in plasma samples were enriched using Top 12 abundant protein depletion columns. Further pro...
Interleukins and inflammatory markers are useful in predicting the severity of acute pancreatitis
Interleukins and inflammatory markers are useful in predicting the severity of acute pancreatitis, 2020
Acute pancreatitis (AP) is a disease with significant morbidity and mortality. The aim of this study was to evaluate the predictive role of inflammatory markers, particularly interleukins (ILs), in the course of AP and to determine the frequency of etiologic factors of AP. We included patients with AP who were treated at our institution from May 1, 2012 to January 31, 2015. Different laboratory parameters, including ILs, and the severity scoring systems Ranson’s criteria and Bedside Index of Severity in Acute Pancreatitis (BISAP) were analyzed. AP was classified into mild and severe, and independent parameters were compared between these groups. The predictive performance of each parameter was evaluated using receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC). A binomial logistic regression was performed to evaluate Ranson’s criteria and IL6, IL8, and IL10 (at admission and after 48 hours) in the course of AP. Overall, 96 patients were treated, 59 (61.5%) males and 37 (38.5%) females, average age 62.5 ± 16.8 years (range 22–91 years). The best predictor for the severity of AP was IL6, measured 48 hours after admission (AUC = 0.84). Other useful predictors of the severity of AP were lactate dehydrogenase (p < 0.001), serum glucose (p < 0.006), and difference in the platelet count (p < 0.001) between admission and after 48 hours (p < 0.001), hemoglobin (p < 0.027) and erythrocytes (p < 0.029). The major causes of AP were gallstones and alcohol consumption. According to our results, IL6 and Ranson score are important predictors of the severity of AP.
Proinflammatory cytokines in alcohol or gallstone induced acute pancreatitis. A prospective study
JOP : Journal of the pancreas, 2009
If differences of inflammatory pathways in acute pancreatitis exist for various etiologies, selective and specific antiinflammatory and other modulatory treatment regimens might be indicated. Circulating levels of prominent proinflammatory cytokines IL-6, 8, 18, and TNF-alpha were measured in patients having their first attack of either alcohol- or gallstone-induced acute pancreatitis. Seventy-five consecutive patients were prospectively included over a 15-month period, sixty of them being either alcohol- or gallstone-induced. All patients were treated according to a standardized algorithm. Blood samples were obtained immediately on admission and, again, at days 1, 2, and 14. A significant effect of the etiology on the levels of IL-8 in the alcohol group as compared to the gallstone group (P=0.003) was found. No etiologic differences were observed for IL-6, IL-18, TNF-alpha, or CRP. Furthermore, no significant differences, either regarding the need for treatment at the intensive car...
C-reactive protein levels in acute pancreatitis and its clinical significance
International Surgery Journal, 2019
Background: Acute pancreatitis is one of the most common problems faced by surgeon in their practice. Alcohol being one of the most important etiology in country like India. The most common line of management has always been conservative until and unless surgery is indicated for its complications. Till date amylase and lipase have been used as diagnostic tool for it however certain prognostic tools like CRP are still under evaluation. Thus we have made an attempt to evaluate its significance as a prognostic tool in this study.Methods: A hospital based observational comparative prospective study was done with 100 patients to measure C-reactive protein (CRP) levels in patients of acute pancreatitis and evaluate if CRP levels predict the severity of pancreatitis.Results: The mean serum CRP level of patients with Ranson’s score <3 was significantly higher as compared to mean serum CRP level of patients with Ranson’s score ≥3 (10.54±5.00 mg/l vs 7.29±3.94 mg/l). There was significant ...
ISSN: 0975-8585 Biochemical Variations in Acute Pancreatitis
2013
Acute pancreatitis is a pancreatic inflammatory disease. The pathologic spectrum of acute pancreatitis varies from interstitial pancreatitis, which is usually a mild and self-limited disorder, to necrotizing pancreatitis, in which the degree of pancreatic necrosis correlates with the severity of the attack.Pancreatitis results when proteolytic enzymes are activated in the pancreas rather than in the intestinal lumen. Endotoxins, exotoxins, viral infections, ischemia, anoxia, and direct trauma are believed to activate these proenzymes. Activated proteolytic enzymes, digest pancreatic and peripancreatic tissues and bring about a severe damage. Elevated levels of serum amylase and lipase establish the diagnosis of acute pancreatitis.Aim of the study was to, i.determine the ratio of serum lipase to serum amylase(L/A) in alcoholic and nonalcoholic pancreatitis patients as compared to age and sex matched normal healthy persons and also to find out whether this index will be useful in differentiating pancreatitis of alcoholic etiology from that of nonalcoholic. Serum amylase and lipase levels were estimated in fifty acute pancreatitis patients (in which 50% were alcoholic and 50% were nonalcoholic) and fifty age and sex matched normal controls. Assay was done automated clinical chemistry analyzer.Lipase/Amylase was calculated. Both the enzymes were elevated in all acute pancreatitis patients, but the rise in amylase was double in nonalcoholic pancreatitis as compared to alcoholics. The extent of elevation of lipase was the same in both the groups of pancreatitis patients. L/A ratio was more than 4 in alcoholics and more than 2 in nonalcoholic pancreatitis patients. L/A ratio might help to differentiate the alcoholic and nonalcoholic pancreatitis, and thus it might have a significant role in establishing the etiology of the disease.Further studies need to be done in larger population of pancreatitis patients.
Revista Romana de Medicina de Laborator
Introduction. Timely assessment of severity of acute pancreatitis is needed to avoid severe systemic complications by making optimal therapeutic approach and correct prognosis of the disease. The aim of the study was to establish the role of several inflammatory biomarkers and coagulation parameters in prediction of AP severity, and also to propose a mathematical formula which allows their combined use for the same purpose. Material and Methods. The prospective study included 70 patients with AP. The patients were divided into groups: mild (group I), moderate (group II) and severe AP (group III). All patients were further classified into two groups: group A (mild AP) and group B (moderate and severe AP). Biochemical markers, inflammatory biomarkers and coagulation factors were tested in all patients. Results. Based on the results of Mann-Whitney,s test, it can be concluded that groups A and B are significant different from each other for CRP (p<0.05). Using the Wald’s stepwise fo...
Role of Biomarkers in Diagnosis and Prognostic Evaluation of Acute Pancreatitis
Journal of Biomarkers, 2015
Acute pancreatitis is a potentially life threatening disease. The spectrum of severity of the illness ranges from mild self-limiting disease to a highly fatal severe necrotizing pancreatitis. Despite intensive research and improved patient care, overall mortality still remains high, reaching up to 30–40% in cases with infected pancreatic necrosis. Although little is known about the exact pathogenesis, it has been widely accepted that premature activation of digestive enzymes within the pancreatic acinar cell is the trigger that leads to autodigestion of pancreatic tissue which is followed by infiltration and activation of leukocytes. Extensive research has been done over the past few decades regarding their role in diagnosis and prognostic evaluation of severe acute pancreatitis. Although many standalone biochemical markers have been studied for early assessment of severity, C-reactive protein still remains the most frequently used along with Interleukin-6. In this review we have di...
Severity markers in patients with acute pancreatitis
Open Medicine, 2014
To evaluate the effectiveness of serum levels of resistin and CD14 expression in monocytes, and high-sensitivity C-reactive protein (hsCRP) in early stages of acute pancreatitis and correct prediction of the severity of acute pancreatitis (AP) using scoring systems. The study involved 10 (29.41%) male and 24 (70.59%) female patients (total n=34) followed for AP diagnosis at the Department of General Surgery, Ataturk University Medical School between July 2008 and September 2009. In all the patients, Ranson and APACHE II scores, serum resistin, hsCRP, and monocyte CD14 expression levels were determined. The patients were divided into two groups as mild and severe AP groups. A control group was formed and the intergroup comparisons were made. Values ≥ 3 based on the Ranson scoring scale and values ≥ 8 in APACHE II scoring scale were considered to indicate severe AP. Evaluations were based on the values obtained on the 1st and 7th days for serum resistin and hsCRP levels and monocyte C...
Digestive Diseases and Sciences, 1993
With the aim of studying the clinical usefulness and applicability of circulating levels of protease inhibitors, complement factors, acute phase reactants, and leukocytic enzymes in the prognostic evaluation of acute pancreatitis (AP), the present prospective multicenter study has been carried out. A total of 182 patients with AP have been included, to whom an exhaustive evolutive protocol has been applied from the time of their hospital admission (2–12 hr from the onset of the disease) until the 15th day of evolution in order to clearly define them. The severe episodes exhibit a greater consumption of α2-macroglobulin, and C3 and C4 complement factors, as well as a greater increase of α1-protease inhibitor, C-reactive protein and polymorphonuclear elastase than mild events, with regards to the underlying pathophysiological condition. The determination of the plasma levels of leukocytic elastase in the first hours of evolution allows a prediction of the severity of the acute pancreatitis event with a high reliability (predictive values that become higher than 90%). The clinical value of the remaining parameters analyzed, in this aspect, is less, being applicable to the monitoring of the disease.