Early predictors of severe acute pancreatitis

Mortality of patients with severe acute pancreatitis (SAP) approaches 30%-40%. An imbalance between the early systemic inflammatory response syndrome (SIRS), and the later compensatory counter-inflammatory response, and development of multiple organ failure (MOF) are considered to be the primary causes of morbidity and mortality in SAP. Excessive leukocyte activation (including neutrophils and monocyte-macrophage lineage) with cytokinemia play a critical role in the pathogenesis of pancreatitis and even more so, of the subsequent inflammatory response. It has been hypothesized that fatal pancreatitis is a consequence of abnormal phagocytic leukocyte hyperstimulation due to deregulation in T- and B-lymphocyte activation. However, the role of lymphocyte activation and its relation to the severity of disease in humans is still poorly understood. Another important drawback is that the majority of information about the alterations of the immune system during the AP comes from in vitro and in vivo studies, and therefore is not always directly applicable and relevant to the clinical situation in human AP.

A research article to be published on April 21, 2010 in the World Journal of Gastroenterology addresses this question. The research team led by Dambrauskas from Department of Surgery, Kaunas University of Medicine, confirmed that human severe and necrotizing AP is characterized by the significant depletion of circulating lymphocytes.

The study demonstrates that serum interleukin (IL)-6 and macrophage migration inhibitory factor (MIF) concentrations are the best discriminators of severe and necrotiz¬ing AP as well as possible fatal outcome during the early course of the disease. These cytokines could also be used as early predictors of local (pancreatic necrosis) and systemic complications (SIRS, MOF) later in the course of the disease. Deregulation of the cellular immune system is a key event leading to the development of severe and necrotizing AP. Infiltration of peripheral organs by aberrantly activated inflammatory cells leads to the development of MOF.

Reference: Dambrauskas Z, Giese N, Gulbinas A, Giese T, Berberat PO, Pundzius J, Barauskas G, Friess H. Different profiles of cytokine expression during mild and severe acute pancreatitis. World J Gastroenterol 2010; 16(15): 1845-1853

http://www.wjgnet.com/1007-9327/full/v16/i15/1845.htm

Correspondence to: Zilvinas Dambrauskas, MD, PhD, Department of Surgery, Kaunas University of Medicine, Eiveniu Str. 2, 50009 Kaunas, Lithuania. zilvinas.dambrauskas@gmail.com

Telephone: +370-37-326218 Fax: +370-37-327163

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H. pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2008 IF: 2.081. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.