Document Detail


Inflammatory mediators in human acute pancreatitis: clinical and pathophysiological implications.
MedLine Citation:
PMID:  10986216     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The time course and relationship between circulating and local cytokine concentrations, pancreatic inflammation, and organ dysfunction in acute pancreatitis are largely unknown. PATIENTS AND METHODS: In a prospective clinical study, we measured the proinflammatory cytokines interleukin (IL)-1 beta, IL-6 and IL-8, the anti-inflammatory cytokine IL-10, interleukin 1 beta receptor antagonist (IL-1RA), and the soluble IL-2 receptor (sIL-2R), and correlated our findings with organ and systemic complications in acute pancreatitis. In 51 patients with acute pancreatitis admitted within 72 hours after the onset of symptoms, these parameters were measured daily for seven days. In addition, 33 aspirates from ascites and the lesser sac were measured. RESULTS: Sixteen patients had mild acute pancreatitis (AP) and 35 severe AP (Atlanta classification); 18 patients developed systemic complications requiring treatment. All mediators were increased in AP. sIL-2R, IL-10, and IL-6 were significantly elevated in patients with distant organ failure. An imbalance in IL-1 beta/IL-1RA was found in severe AP and pulmonary failure. Peak serum sIL-2R predicted lethal outcome and IL-1RA was an early marker of severity. IL-6 was the best prognostic parameter for pulmonary failure. CONCLUSION: Our results suggest that local mediator release, with a probable IL-1 beta-IL-1RA imbalance in severe cases, is followed by the systemic appearance of pro- and anti-inflammatory mediators. The pattern of local and systemic mediators in complicated AP suggests a role for systemic lymphocyte activation (triggered by local release of mediators) in distant organ complications in severe AP.
Authors:
J Mayer; B Rau; F Gansauge; H G Beger
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Gut     Volume:  47     ISSN:  0017-5749     ISO Abbreviation:  Gut     Publication Date:  2000 Oct 
Date Detail:
Created Date:  2000-12-07     Completed Date:  2000-12-07     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  2985108R     Medline TA:  Gut     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  546-52     Citation Subset:  AIM; IM    
Affiliation:
Department of General Surgery, University Hospital of Ulm, Ulm, Germany.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Aged
Aged, 80 and over
Female
Humans
Inflammation Mediators / blood*
Interleukin-1 / blood
Interleukin-10 / blood
Interleukin-6 / blood
Interleukin-8 / blood
Male
Middle Aged
Multiple Organ Failure / blood,  etiology
Pancreatitis / blood*,  complications
Prognosis
Prospective Studies
Receptors, Interleukin-1 / antagonists & inhibitors,  blood
Receptors, Interleukin-2 / blood
Severity of Illness Index
Chemical
Reg. No./Substance:
0/Inflammation Mediators; 0/Interleukin-1; 0/Interleukin-6; 0/Interleukin-8; 0/Receptors, Interleukin-1; 0/Receptors, Interleukin-2; 130068-27-8/Interleukin-10
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