Abstract
The aim of this study was to compare the sensitivity, specificity, and diagnostic accuracy of serum interleukin-6, interleukin-8,β 2-microglobulin, and C-reactive protein in the assessment of the severity of acute pancreatitis using commercial kits for their respective assays. Thirty-eight patients with acute pancreatitis (25 men, 13 women, mean age 59 years, range 16–97) were studied; the diagnosis was based on prolonged upper abdominal pain associated with a twofold increase of serum lipase, and it was confirmed by imaging techniques. According to the Atlanta criteria, 15 patients had severe illness and 23 had mild disease. The four serum markers were determined in all patients on admission, as well as daily for the following five days. On the first day of the disease, the sensitivity (calculated on patients with severe pancreatitis), specificity (calculated on patients with mild pancreatitis), and the diagnostic accuracy of these serum markers for establishing the severity of acute pancreatitis were 100%, 86%, and 91% for interleukin-6 (cutoff level 2.7 pg/ml); 100%, 81%, and 88% for interleukin-8 (cutoff level 30 pg/ml); 58%, 81%, and 73% forβ 2-microglobulin (cutoff level 2.1 mg/liter); and 8%, 95%, and 64% for C-reactive protein (cutoff level 11 mg/dl). The results of our study indicate that, when assayed during the first 24 hr of disease onset, interleukin-6 and interleukin-8 are better markers thanβ 2-microglobulin or C-reactive protein for evaluating the severity of acute pancreatitis.
Similar content being viewed by others
References
Leser HG, Gross V, Scheibenbogen C, Heinisch A, Salm R, Lausen M, Ruckauer K, Andreesen R, Farthmann EH, Scholmerich J: Elevation of serum interleukin-6 concentration precedes acute-phase response and reflects severity in acute pancreatitis. Gastroenterology 101:782–785, 1991
Viedma JA, Perez-Mateo M, Dominguez JE, Carballo F: Role of interleukin-6 in acute pancreatitis. Comparison with C-reactive protein and phospholipase A. Cut 33:1264–1267, 1992
Hamilton G, Hofbauer S, Hamilton B: Endotoxin, TNF-alpha, interleukin-6 and parameters of the cellular immune system in patients with intraabdominal sepsis. Scand J Infect Dis 24:361–368, 1992
Heath DI, Cruickshank A, Gudgeon M, Jehanli A, Shenkin A, Imrie CW: Role of interleukin-6 in mediating the acute phase protein response and potential as an early means of severity assessment in acute pancreatitis. Gut 34:41–45, 1993
Curley PJ, McMahon MJ, Lancaster F, Banks RE, Barclay GR, Shefta J, Boylston AW, Whicher JT: Reduction in circulating levels of CD4-positive lymphocytes in acute pancreatitis: Relationship to endotoxin, interleukin 6 and disease severity. Br J Surg 80:1312–1315, 1993
Gross V, Andreesen R, Leser HG, Ceska M, Liehl E, Lausen M, Farthmann EH, Scholmerich J: Interleukin-8 and neutrophil activation in acute pancreatitis. Eur J Clin Invest 22:200–203, 1992
Manicourt D, Brauman H, Orloff S: Plasma and urinary levels ofβ 2-M in rheumatoid arthritis. Ann Reum Dis 37:328–332, 1978
Descos L, Beorchia S, Vincent C, Revillard JP: Serum levels ofβ2M. A new marker of activity in Crohn's disease. N Engl J Med 301:440–441, 1979
Forman DT: Beta-2 microglobulin. An immunogenetic marker of inflammatory and malignant origin. Ann Clin Lab Sci 12:447–452, 1982
Bradley EL: A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, GA, September 11–13, 1992. Arch Surg 128:586–590, 1993
Pezzilli R, Billi P, Fiocchi M, Beltrandi E, Cappelletti O, Sprovieri G, Miglioli M: Serumβ 2-microglobulin in chronic diseases of the pancreas. Int J Pancreatol 17:161–165, 1995
Pezzilli R, Billi P, Platè L, Bongiovanni F, Morselli Labate AM, Miglioli M: Human pancreas-specific protein/procar-boxypeptidase B: A useful serum marker of acute pancreatitis. Digestion 55:73–77, 1994
Lusted LB: Decision-making studies in patient management. N Engl J Med 284:416–424, 1971
Robertson EA, Zweig MH: Use of receiver operating characteristic curves to evaluate the clinical performance of analystical systems. Clin Chem 27:1569–1574, 1981
Turkey JW: Exploratory Data Analysis. Reading, Massachusetts: Addison-Wesley, 1977
Steinberg WM: Predictors of severity of acute pancreatitis. Gastroenterol Clin North Am 19:849–861, 1990
Agarwal N, Pitchumoni CS: Assessment of severity in acute pancreatitis. Am J Gastroenterol 86:1385–1391, 1991
Mayer AD, McMahon MJ, Bowen M, Cooper EH: C Reactive protein: An aid to assessment and monitoring of acute pancreatitis. J Clin Pathol 37:207–211, 1984
Gross V, Scholmerich J, Leser HG, Salm R, Lausen M, Ruckauer K, Schoffel U, Lay L, Heinisch A, Farthmann EH: Granulocyte elastase in assessment of severity of acute pancreatitis. Comparison with acute-phase proteins C-reactive protein,α 1-antitrypsin, and protease inhibitorα 2-macroglobulin. Dig Dis Sci 35:97–105, 1990
Buchler M, Malfertheiner P, Schadlich H, Nevalainen TJ, Friess H, Beger HG: Role of phospholipase A2 in human acute pancreatitis. Gastroenterology 97:1521–1526, 1989
Exley AR, Leese T, Holliday MP, Swann RA, Cohen J: Endotoxaemia and serum tumour necrosis factor as prognostic markers in severe acute pancreatitis. Gut 33:1126–1128, 1992
Pezzilli R, Billi P, Platè L, Barakat B, Biongiovanni F, Miglioli M: Human pancreatic secretory trypsin inhibitor in the assessment of the severity of acute pancreatitis. A comparison with C-reactive protein. J Clin Gastroenterol 19:112–117, 1994
Pezzilli R, Billi P, Gullo L, Beltrandi E, Malbini M, Mancini R, Incorvaia L, Miglioli M: Behavior of serum soluble interleukin-2 receptor, soluble CD8 and soluble CD4 in the early phases of acute pancreatitis. Digestion 55:268–273, 1994
Le J, Vilcek J: Biology of disease. Interleukin 6: A multifunctional cytokine regulating immune reactions and the acute phase protein response. Lab Invest 61:588–602, 1989
Byl B, Roucloux I, Crusiaux A, Dupont E, Deviere J: Tumor necrosis factor alpha and interleukin 6 plasma levels in infected cirrhotic patients. Gastroenterology 104:1492–1497, 1993
Hyams JS, Fitzgerald JE, Treem WR, Wyzga N, Kreutzer DL: Relationship of functional and antigenic interleukin 6 to disease activity in inflammatory bowel disease. Gastroenterology 104:1285–1292, 1993
Deviere J, Content J, Crusiaux A, Dupont E: IL-6 and TNF-α in ascitic fluid during spontaneous bacterial peritonitis. Dig Dis Sci 36:123–124, 1991
Mahida YR, Kurlac L, Gallagher A, Hawkey CJ: High circulating concentrations of interleukin-6 in active Crohn's disease but not ulcerative colitis. Gut 32:1531–1534, 1991
Goodman AJ, Bird NC, Johnson AG: Antiprotease capacity in acute pancreatitis. Br J Surg 73:796–798, 1986
Schulz HU, Schmidt D, Kunz D, Meyer F, Lippert H: Altered immune function in acute pancreatitis: Pathogenic role and prognostic indicator? Digestion 54:307–308, 1993
Nijsten MW, DeGroot ER, TenDuis HJ, Klesen HJ, Hack CE, Aarden LA: Serum levels of interleukin-6 and acute phase responses. Lancet 2:921, 1987
Van Oers MHJ, van der Heyden AAPAM, Aarden LA: Interleukin 6 (IL-6) in serum and urine of renal transplant recipients. Clin Exp Immunol 71:314–319, 1988
Rinderknecht H: Fatal pancreatitis, a consequence of excessive leukocyte stimulation? Int J Pancreatol 3:105–112, 1988
Waage A, Brandtzaeg P, Halstensen A, Kierulf P, Espevik T: The complex pattern of cytokines in serum from patients with meningococcal septic shock. Association between interleukin-6, interleukin-1, and fatal outcome. J Exp Med 169:333–338, 1989
Nishimoto N, Yoshizaki K, Tagoh H, Monden M, Kishimoto S, Hirano T, Kishimoto T: Elevation of serum interleukin-6 prior to acute phase proteins on the inflammation by surgical operation. Clin Immunol Immunopathol 50:399–401, 1989
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Pezzilli, R., Billi, P., Miniero, R. et al. Serum interleukin-6, interleukin-8, andβ 2-Microglobulin in early assessment of severity of acute pancreatitis comparison with serum C-reactive protein. Digest Dis Sci 40, 2341–2348 (1995). https://doi.org/10.1007/BF02063235
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02063235