Interleukin-6 Concentration in Early Assessment of Severity and Prediction of Outcome among Patients with Acute Pancreatitis: A Prospective Cohort Study

Abstract

Introduction: Various inflammatory markers, such as C-reactive Protein (CRP), Interleukin (IL), and Tumour Necrosis Factor (TNF), are used as indicators of illness severity in acute pancreatitis. Concentrations of inflammatory mediators are correlated to the severity of the disease. If detected before the occurrence of multiple organ dysfunction, early initiation of aggressive therapy might prevent its development. IL-6, released by macrophages in response to tissue injury, peaks 24 hours after the onset of inflammation and can be used to predict early disease severity. The Bedside Index of Severity in Acute Pancreatitis (BISAP) scoring system was used to assess the severity of acute pancreatitis. Aim: To study the association of IL-6 levels with the BISAP in predicting the outcome. Materials and Methods: A prospective cohort study was conducted in the Department of General Surgery at Government Medical College, Kottayam, Kerala, India. The duration of the study was 12 months, from January 1, 2019 to December 31, 2019. The study was done on patients of either gender, aged between 18 and 60 years, with clinical features suggestive of acute pancreatitis. After obtaining informed consent, a 4 mL venous blood sample was taken, and serum amylase and serum lipase levels were estimated. If serum amylase/lipase levels were three times above the normal range, a diagnosis of acute pancreatitis was made according to revised Atlanta criteria. Meanwhile, the BISAP score was calculated. After reaching a sample size of 77 for the present study, IL-6 estimation was performed using an Enzyme-linked Immunoassay (ELISA) kit. At the end of the study, IL-6 concentration was compared with the BISAP score to assess severe acute pancreatitis. The data entered in Microsoft Excel were analysed using the Chi-square test and Fisher’s-exact test. Results: The mean age of the study participants was 30 years, with 37 patients (48%) between the ages of 20-40 years and 40 patients (52%) between the ages of 40-60 years. Out of the 77 study subjects, 71 were males and six were females. There was a significant association between Intensive Care Unit (ICU) admission with persistent organ failure, which indicates severe acute pancreatitis. Conclusion: In the present study, no significant association was found between IL-6 and the BISAP score in the early assessment and prediction of the severity of acute pancreatitis.