Cytokines may predict outcome at acute pancreatic patients with pulmonary failure: the beneficial role of somatostatin

Introduction

Acute pancreatic patients with lung injury have high mortality rate. Despite pretreatment with imipenem, inflammatory response is present generally and locally thanks to the cytokines that are responsible for systemic inflammatory response syndrome (SIRS) and multiple organ disfunction syndrome (MODS).

Aim of the study

Evaluating acute pancreatic patients, to confirm cytokine involvement in the appearance of pulmonary failure and to investigate the effect of somatostatin on some cytokines associated with lung injury.

Materials and methods

In a 1-year prospective clinical study we examined 22 patients with severe pancreatitis acuta. Eleven of them (group I) were treated early with somatostatin (0.1 mg every 8 hours for 7 days). The second group was treated with standard therapy. The pulmonary failure was assessed on the basis of radiographic findings, computerised tomography scans, bacteriological diagnosis of endotracheal aspirates and acid–base abnormalities. Serum concentrations of IL-1, IL-6 and TNF-α were determined during the time course of the study, as were white blood cell counts, amylases, transaminases, urea and creatinin.

Results

All 22 patients developed MODS and all laboratory parameters as indicators of SIRS were increased. Serum concentrations of IL-1, IL-6 and TNF-α were elevated in all patients, but with high significance difference (P < 0.03) in 14 patients who developed pulmonary failure (three from group I and all 11 patients from group II). The peak serum concentrations of cytokines were found in patients from group II with the most increased value for IL-6. Lung injury treated with mechanical ventilation (14 patients), pulmonary drainage (six patients) and even decorticating (three patients) correlated with increased serum value of IL-6. Changes in chest radiographs depended on the increased values of all cytokines and the more severe was lung injury, the higher were the values. Comparison between the patients from group I and those from group II showed significant differences in the values of cytokines, with the values being higher in group II. Serum concentration of cytokines were significantly higher (P < 0.05) in five patients who died (all of them with pulmonary failure) compared with those who survived.

Conclusion

High cytokine values are associated with development of pulmonary failure and increased mortality at acute pancreatic patients. Initial aggressive treatment with somatostatin decreases cytokine release and may predict good outcome in these patients by reducing the appearance and severity of pulmonary failure.