Anant Indaram

Cytokines (IL-6, IL-8, TNF): early and reliable predictors of severe acute pancreatitis.

Background Severe acute pancreatitis is associated with a high mortality, especially when compared with mild acute pancreatitis. Early intervention in patients with severe acute pancreatitis has been shown to improve mortality. The value of cytokines (interleukin [IL]-6, IL-8 and tumor necrosis factor [TNF]-alpha) in diagnosing severe acute pancreatitis at an early stage was studied. Study Thirty-six patients with acute pancreatitis were prospectively evaluated. Age-matched controls were obtained from healthy volunteers. Levels of IL-6, IL-8, and TNF-alpha were obtained within 24 hours of admission. Ransons prognostic signs and Banks clinical criteria were used to differentiate patients into mild and severe pancreatitis. Results There was significant difference in IL-6 levels between controls and mild pancreatitis, controls and severe pancreatitis, and mild and severe pancreatitis. IL-8 levels were significantly different between controls and severe pancreatitis and mild and severe pancreatitis. There was no significant difference between controls and mild pancreatitis. The results for TNF-alpha were similar to the findings for IL-8. Conclusion IL-6, IL-8, and TNF can be used independently in differentiating mild acute pancreatitis from early severe acute pancreatitis.

CAUSES OF ACUTE AND RECURRENT PANCREATITIS: Clinical Considerations and Clues to Diagnosis

The causes of acute pancreatitis are well documented and usually are divided into alcohol-induced, gallstone, miscellaneous, and idiopathic when no immediate cause is found. Clinically, the cause is either immediately discernable from the history and a few standard investigations, less obvious and requiring more detailed studies, or obscure and even speculative. The physician can whittle away at the idiopathic group by increasingly recognizing causes such as biliary sludge or microlithiasis, sphincter of Oddi dysfunction, hereditary pancreatitis, cystic fibrosis, or autoimmune causes. The prevalence of these and other rare conditions is the focus of intense research. Whether these increasingly recognized causes will significantly alter the current incidence of 10% to 30% of cases classified as idiopathic pancreatitis, only time will tell.