Plasma anti‐inflammatory cytokines and monocyte human leucocyte antigen‐DR expression in patients with acute pancreatitis

Abstract

Background: Immune suppression plays a role in the pathogenesis of acute pancreatitis. The purpose was to describe plasma anti‐inflammatory cytokines and blood monocyte human leucocyte antigen (HLA)‐DR expression, a cellular marker of immune suppression, in relation to clinical outcome in acute pancreatitis. Methods: We studied 74 patients with acute pancreatitis admitted within 72 h after symptom onset; 27 had mild disease and 47 severe disease, of whom 20 developed organ failure. Plasma cytokine concentrations and monocyte HLA‐DR density were determined at admission and 1, 2, 3, 7, 14 and 21 days later. Results: The levels of interleukin‐1 receptor antagonist, interleukin‐6 and interleukin‐10 correlated inversely to monocyte HLA‐DR expression; each marker correlated with disease severity. Interleukin‐4, ‐11 and ‐13 levels were low. Organ failure occurred at median 36 h (range 8 to 158) after admission and was predicted at admission by the combination of interleukin‐6 and interleukin‐10 with sensitivity of 95%, specificity of 88% and positive likelihood ratio of 7.6 (95% confidence interval 3.3 to 17). Patients with secondary infections had a lower proportion of HLA‐DR positive monocytes than did controls at day 14 (median: 32% versus 65%; n = 7) and at day 21 (median: 49% versus 83%; n = 6), P < 0.05 each. In the organ failure group, HLA‐DR expression did not differ between survivors and non‐survivors. Conclusions: Determining the severity of anti‐inflammatory reaction at admission and monitoring the course of immune suppression provide a means for predicting clinical outcome in acute pancreatitis.