Inflammatory response, prognostic scores and mortality in acute pancreatitis

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Objective

The object of the study was to relate, in the first 72 h following hospital admission, biochemical markers of inflammatory response and prognostic scores to mortality in acute pancreatitis (AP).

Materials and methods

For a year (November 1997 to October 1998) a prospective study was made consecutively of 30 patients admitted to the Emergency Department where AP was diagnosed; 83.3% were in the Intensive Care Unit (ICU) with three or more Ranson criteria and 24 h APACHE score >8. At 12, 36, 48 and 72 h biochemical parameters were measured: elastase, C-reactive protein (CRP), interleukin (IL)-6, IL-8 and Tumor Necrosis Factor (TNF). At the same time 24, 48 and 72 h, APACHE scores and 24 and 48 h Ranson scores were assessed.

Results

Thirty patients with a mean age of 62.7 (13.5) years were studied. 60% were women and 80% had biliary etiology. The median interval from pain until hospital admission was 16.6 h. 67% showed C or D grade Balthazar Scale. 60% had surgery at 38 days median period. 56.7% had some complications and the hospital mortality was 16.7%. In relation to mortality there was a significant difference (T-test) in the number of dysfunctional organs 3.8(1.3) vs 1.7(1.2) and in the Multiple Organ Dysfunction (MOD) score 8.8 (6) vs 3 (2.2).

Conclusions

In the nonsurvival group, IL-8 increased significantly in the first 30 h and CPR, IL-8 and TNF between 30 and 48 h. Between 48-72 h, TNF continued to increase. There were differences in APACHE and Ranson Scores, but these were only significant at 48 h.

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