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

  • 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)
Published Article
Digestive Diseases and Sciences
Publication Date
Oct 27, 2017
DOI: 10.1007/s10620-017-4813-6
Springer Nature


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.

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