Abstract
ObjectiveFew data are available on the role of T lymphocytes and inflammatory cytokines in abdominal compartment syndrome (ACS) in severe acute pancreatitis (SAP). We conducted a retrospective study to assess the risk factors associated with ACS in SAP.MethodsA total of 76 SAP patients who were admitted within 24 hours after symptom onset in our study. There were 36 patients suffering from ACS and 40 from intra-abdominal hypertension (IAH). On the 1st, 3rd and 7th days after hospital admission, the following variables were assessed: serum value of C-reactive protein (CRP), and the proportions of peripheral CD4+ and CD8+ T lymphocytes. Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and computed tomography severity index (CTSI) score were assessed on days 1 and 7 after hospitalization.ResultsCompared with the patients with IAH, ACS patients showed statistically higher CRP value on 7th day after hospital admission, proportions of CD4+ T cells on days 1, 3, 7 and CD4+ / CD8+ ratio on day 1 were significantly lower (P < 0.05, respectively). A CD4+ T cell proportion of 30.3% on the 1st day indicated ACS with an area under the curve (AUC) of 0.774, a sensitivity with 82.5% and specificity with 72.0%, respectively. Sensitivity / specificity for predicting ACS in SAP patients on day 1 was 70.0% / 68.0% for CD4+ / CD8+ ratio, 72.2% / 65.0% for APACHE II score.ConclusionsThe reduction of peripheral blood CD4+ T lymphocytes is associated with ACS in SAP, and may act as a potential predictor of ACS in SAP.
Highlights
Acute pancreatitis (AP) is a mild and self-limiting disease, and approximately 80% of AP patients recover without complications [1]
The reduction of peripheral blood CD4+ T lymphocytes is associated with abdominal compartment syndrome (ACS) in Severe acute pancreatitis (SAP), and may act as a potential predictor of ACS in SAP
De Waele et al [11] found that intra-abdominal pressure (IAP) above 25 mmHg was detected in 30% of SAP patients, while IAP > 15 mmHg was found in 78% of SAP patients
Summary
Acute pancreatitis (AP) is a mild and self-limiting disease, and approximately 80% of AP patients recover without complications [1]. SAP accounts for around 20% of AP patients, and is associated with a mortality rate ranging from 36% to 50% [2,3]. Severe acute pancreatitis (SAP) is most commonly characterized by cytokine activation, pancreatic necrosis, systemic inflammatory response syndrome (SIRS), and multiple organ dysfunction syndrome (MODS) [4,5]. Intra-abdominal hypertension (IAH) is defined as sustained increase of intra-abdominal pressure (IAP) > 12 mmHg, and abdominal compartment syndrome (ACS), a lethal complication of SAP, is defined as the combination of IAP > 20 mmHg and new-onset organ failure (OF) or acute worsening of existing OF [10]. The symptoms of ACS may resemble those of other complications, such as infected pancreatic necrosis, SIRS, and MODS [12]. SAP is a critical risk factor for ACS, it is necessary to routinely monitor IAP in SAP patients according to the 2013 WSACS guidelines [10]
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