Serum Proinflammatory Cytokine Levels and White Blood Cell Differential Count in Patients with Different Degrees of Severity of Acute Alcoholic Pancreatitis
Languages of publication
Several studies suggest that cytokines and neutrophils play an important role in the pathogenesis of acute pancreatitis (AP).The aim of the study was to assess the systemic release of proinflammatory cytokines and WBC (white blood cells) count with differential in patients with acute alcoholic pancreatitis (AAP) and to characterize the differences between patients with mild and severe forms of the disease.Material and methods. Thirty-five patients with the mild form of acute alcoholic pancreatitis (MAAP) were compared to 11 patients with severe acute alcoholic pancreatitis (SAAP). Serum levels of IL-6, IL-8, IL-12p40 and WBC differential count were measured every second day during the first week after admission.Results. During the course of the study, the average level of IL-6 was significantly (p<0.05) higher in patients with SAAP than in patients with the mild form of the disease (MAAP). Serum levels of IL-8 and IL-12p40 on admission were higher in patients with SAAP than in patients with MAAP but the difference was not statistically significant. Of all the types of WBCs, neutrophils were significantly (p<0.05) elevated the entire time in SAAP patients when compared to patients with MAAP on 5th and 7th day from admission to hospital.Conclusions. Patients with SAAP had significantly higher proinflammatory cytokine IL-6 levels and neutrophil counts than patients with MAAP. The results suggest that proliferation and overstimulation of this subset of leukocytes might contribute to the development of the systemic inflammatory response in patients with SAAP.
1 - 5 - 2012
4 - 7 - 2012
- 2 Department of General Surgery, Jagiellonian University Medical College in Cracow
- Department of Diagnostics, Chair of Clinical Biochemistry, Jagiellonian University Medical College in Cracow
- 2 Department of General Surgery, Jagiellonian University Medical College in Cracow
- School of English, Faculty of Medicine in Cracow, Jagiellonian University Medical College
- Dufour MC, Adamson MD: The epidemiology of alcohol-induced pancreatitis. Pancreas 2003; 27: 286-90.[Crossref][PubMed]
- Matar ZS: The clinical pattern of acute pancreatitis: The Al Kharj Experience. Inter J Surg 2007; 11: 1.
- Jaakkola M, Sillanaukee P, Löf K et al.: Amount of alcohol is an important determinant of the severity of acute alcoholic pancreatitis. Surgery 1994; 115: 31-38.[PubMed]
- Apte MV, Pirola RC, Wilson JS: Pancreas: alcoholic pancreatitis - it's the alcohol, stupid. Nat Rev Gastroenterol Hepatol 2009; 6: 321-22.[Crossref][WoS]
- Nordback I, S and J, Andrén-Sandberg Å: Criteria for alcoholic pancreatitis results of an international workshop in Tampere, Finland, June 2006. Pancreatology 2007; 7: 100-04.[WoS]
- Vonlaufen A, Wilson JS, Apte MV: Molecular mechanisms of pancreatitis: Current opinion. J Gastroenterol Hepatol 2008; 23: 1339.[Crossref][PubMed]
- Pandol SJ, Raraty M: Pathobiology of alcoholic pancreatitis. Pancreatology 2007; 7: 105-14.[PubMed][Crossref][WoS]
- Swaroop VS, Chari ST, Clain JE: Severe acute pancreatitis. JAMA 2004; 291: 2865-68.
- Pelli H, Lappalainen-Lehto R, Piironen A et al.: Pancreatic damage after the first episode of acute alcoholic pancreatitis and its association with the later recurrence rate. Pancreatology 2009; 9: 245-51.[WoS][PubMed][Crossref]
- Thal A P, Perry J F, Egner W: A clinical and morphological study of forty-two cases of fatal acute pancreatitis. Surg Gynecol Obstet 1957; 105: 191-202.
- Ranson J HC, Rifkind KM, Roses D F et al.: Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet 1974; 139: 69-81.
- Rinderknecht H: Fatal pancreatitis, a consequence of excessive leukocyte stimulation? Int J Pancreatol 1988; 3: 105-12.
- Granger J, Remick D: Acute pancreatitis: models, markers, and mediators. Shock 2005; 24: 45-51.[PubMed][Crossref]
- Bhatia M, Brady M, Shokuhi S et al.: Inflammatory mediators in acute pancreatitis. J Pathol 2000; 190: 117-25.[WoS]
- Bradley E L III : A clinically based classification system for acute pancreatitis. Arch Surg 1993; 128: 586-90.
- Knaus W, Draper E, Wagner D P et al.: APPACHE II: a severity of disease classification system. Crit Care Med 1985; 77: 633-38.
- Marshall JC, Sibbald WJ, Cook DA et al.: The multiple organ dysfunction score: A reliable indicator of a complex clinical outcome. Crit Care Med 1992; 20: S90.
- Becker V: Pathological anatomy and pathogenesis of acute pancreatitis. World J Surg 1981; 5: 303-13.[PubMed][Crossref]
- Balthazar EJ: CT diagnosis and staging of acute pancreatitis. Radiol Clin North Am 1989; 27: 19-37.[PubMed]
- Mayer J, Rau B, Gansague F et al.: Inflammatory mediators in human acute pancreatitis: clinical and pathophysiological implications. Gut 2000; 47: 546-52.[Crossref][PubMed]
- Apte RC, Pirola JS, Wilson: Molecular Mechanisms of Alcoholic Pancreatitis. Dig Dis 2005; 23: 232-40.[Crossref][PubMed]
- Vonlaufen A, Apte MV, Imhof BA et al.: The role of inflammatory and parenchymal cells in acute pancreatitis. J Pathology 2007; 213: 239-48.[WoS]
- Dauphine Ch, Kovar J, Stabile B et al.: Identification of admission values predictive of complicated acute alcoholic pancreatitis. Arch Surg 2004; 139: 978-82.
- Moreno-Osset E, Lopez A, de la Cueva L et al.: 99mTc-hexamethylpropylene amineoxime leukocyte scintigraphy in acute pancreatitis: an alternative to contrast-enhanced computer tomography? Am J Gastroenterol 2005; 100: 153-61.[Crossref]
- Werner J, Dragotakes SC, Fernandez-del Castillo C et al.: Technetium-99m-labeled white blood cells: a new method to define the local and systemic role of leukocytes in acute experimental pancreatitis. Ann Surg 1998; 227: 86-94.
- Dominguez-Munoz JE, Carballo F, Garcia MJ et al.: Clinical usefulness of polymorphonuclear elastase in predicting the severity of acute pancreatitis: results of a multicentre study. Br J Surg 1991; 78: 1230-34.[Crossref]
- Paulino EC, de Souza LJ, Molan NA et al.: Neutrophils from acute pancreatitis patients cause more severe in vitro endothelial damage compared with neutrophils from healthy donors and are differently regulated by endothelins. Pancreas 2007; 35: 37-41.[Crossref][WoS]
- Cassatella MA: The production of cytokines by neutrophils. Immunol Today 1995; 16: 21-26.[Crossref][PubMed]
- Suwa T, Hogg JC, Klut ME et al.: Interleukin-6 changes deformability of neutrophils and induces their sequestration in the lung. Am J Respir Crit Care Med 2001; 163: 970-76.
- Suwa T, Hogg JC, Quinlan KB et al.: The effect of interleukin-6 on L-selectin levels on polymorphonuclear leukocytes. Am J Physiol Heart Circ Physiol 2002; 283: H879-84.
- Biffl WL, Moore EE, Moore FA et al.: Interleukin-6 delays neutrophil apoptosis. Arch Surg 1996; 131: 24-29.
- Ohmoto K, Yamamoto S: Serum interleukin-6 and interleukin-10 in patients with acute pancreatitis: clinical implications. Hepatogastroenterology 2005; 52: 990-94.
- Pezzilli R, Morselli-Labate A M, Miniero R: Simultaneous serum assays of lipase and interleukin-6 for early diagnosis and prognosis of acute pancreatitis. Clin Chem 1999; 45: 1762-67.
- Stimac D, Fisic E, Milic S et al.: Prognostic values of IL-6, IL-8, and IL-10 in acute pancreatitis. J Clin Gastroenterol 2006; 40: 209-12.
- Sathyanarayan G, Garg PK, Prasad H et al.: Elevated level of interleukin-6 predicts organ failure and severe disease in patients with acute pancreatitis. J Gastroenterol Hepatol 2007; 22: 550-54.[WoS][Crossref]
- Panek J, Karcz D, Pieton R et al.: Blood serum levels of proinflammatory cytokines in patients with different degrees of acute biliary pancreatitis. Can J Gastroenterol 2006; 20: 645-48.
- Strieter R M, Kasahara K, Allen R M et al.: Cytokine-induced neutrophil-derived interleukin-8. Am J Pathol 1992; 141: 397-407.
- Gross V, Andreesen R, Leser HG et al.: lnterleukin-8 and neutrophil activation in acute pancreatitis. Eur J Clin Invest 1992; 22: 200-03.[Crossref]
- Gonzalez-Quintela A, Campos J, Gude F et al.: Serum concentrations of interleukin-8 in relation to different levels of alcohol consumption. Cytokine 2007; 38: 54-60.[Crossref][WoS]
- Cooper A M, Khader SA: IL-12p40: an inherently agonistic cytokine. Trends Immunol 2007; 28: 33-38.[WoS][Crossref]
- Pezzilli R, Miniero R, Cappelletti O et al.: Behaviour of serum interleukin 12 in human acute pancreatitis. Pancreas 1999; 18: 247-251.
Publication order reference