Affordable Access

Access to the full text

Association of Systemic Inflammatory and Anti-inflammatory Responses with Adverse Outcomes in Acute Pancreatitis: Preliminary Results of an Ongoing Study

Authors
  • Sharma, Deepesh1
  • Jakkampudi, Aparna2, 3
  • Reddy, Ratnakar2
  • Reddy, Panyala Balakumar2
  • Patil, Aasish1
  • Murthy, H. V. V.4
  • Rao, G. Venkat5
  • Reddy, D. Nageshwar1
  • Talukdar, Rupjyoti1, 2, 3, 6
  • 1 Asian Institute of Gastroenterology, Department of Medical Gastroenterology, 6-3-661 Somajiguda, Hyderabad, Telangana, 500082, India , Hyderabad (India)
  • 2 Asian Healthcare Foundation, Division of Basic and Translational Sciences, Hyderabad, India , Hyderabad (India)
  • 3 Asian Healthcare Foundation, Wellcome DBT India Alliance Laboratories, Hyderabad, India , Hyderabad (India)
  • 4 Asian Institute of Gastroenterology, Department of Biostatistics, Hyderabad, India , Hyderabad (India)
  • 5 Asian Institute of Gastroenterology, Department of Surgical Gastroenterology, Hyderabad, India , Hyderabad (India)
  • 6 Asian Healthcare Foundation, Pancreas Research Group, 6-3-661 Somajiguda, Hyderabad, Telangana, 500082, India , Hyderabad (India)
Type
Published Article
Journal
Digestive Diseases and Sciences
Publisher
Springer-Verlag
Publication Date
Oct 27, 2017
Volume
62
Issue
12
Pages
3468–3478
Identifiers
DOI: 10.1007/s10620-017-4813-6
Source
Springer Nature
Keywords
License
Yellow

Abstract

IntroductionThis paper reports preliminary data of an ongoing study that evaluates the association of systemic inflammatory response (SIRS) with early severe acute pancreatitis (ESAP) and compensatory anti-inflammatory response syndrome (characterized by HLA-DR down-regulation) with infected pancreatic necrosis (IPN).MethodsConsecutive patients presenting within 72 h of symptom onset with organ dysfunction and/or local complications were included. Following parameters were recorded: demographics, etiology, SIRS, APACHE II, creatinine, BUN. Circulating IL-8, IL-6, IL-10, TNF-alpha concentrations and expression of HLA-DR and IL-10 by qRT-PCR in PBMCs were measured. Strength of associations of cytokine concentration and HLA-DR/IL-10 expression with outcomes was expressed as Hedges’ G and relative risk (95% CI).ResultsTwenty-eight patients (10 MSAP; 18 SAP) fulfilled inclusion criteria. Twelve patients had ESAP and eight presented with organ failure. Admission SIRS worsened in eight (28.6%) patients over 48 h. Sixteen (57.1%) patients developed primary IPN. Twenty-one (75%) patients had HLA-DR down-regulation during the first week, which persisted to the second week in 12 (42.9%) patients. IL-8, IL-6, and TNF-α progressively increased from healthy controls to MAP to MSAP to SAP. IL-6 and TNF-α was higher in the patients who developed ESAP (p = 0.01 and 0.05, respectively). Patients who died within the first week also had a significantly elevated concentration of IL-6 and TNF-α (p = 0.02 and 0.01, respectively). The relative risk (95% CI) of developing primary IPN with persistent HLA-DR down-regulation till the second week of illness was 11.3 (1.6–82.4; p = 0.01).ConclusionsOur study objectively demonstrates significant association of ESAP and early mortality with primary cytokine response, and development of IPN with persistent HLA-DR down-regulation.

Report this publication

Statistics

Seen <100 times