Clinical Value Of Cytokine And BISAP Scoring System In Early Predicting The Severity Of Acute Pancreatitis

Acute pancreatitis (AP) is one of the most common diseases in gastrointestinal surgery. According to the latest classification, AP is an inflammatory condition of pancreas which due to many causes (biliary, alcohol etc.) induced the pancreatic trypsin activation. The main feature of AP is pancreatic inflammation reactions and sometimes associated with multiple organ dysfunction disease. The mild acute pancreatitis is a self-limiting disease which ranges about80%to90%of the patients with only minimal or transitional systemic manifestations, but about20%to30%of patients develop a severe disease that can progress to systemic inflammation and cause pancreatic necrosis, multi-organ failure, and potentially death. The overall mortality rate of AP is2%to5%, but the morality of severe acute pancreatitis (SAP) may up to20%to30%So it is important to assess the disease severity in a timely and accurate manner to provide comprehensive treatment to AP patients, which will allow the doctors to consider more aggressive interventions to prevent adverse outcomes and will decrease the high mortality of SAP. Also reliable markers or score systems predicting the severity of AP is of clinical importance for the management of AP. The early prediction may divided into serological predictors such as amylase, lipase, cytokines and the scoring system such as the Ranson, APACHE II, Glasgow score standard (Imrie standard), and BISAP score system standard). And the purpsose of the current study was to evaluate the cytokins markes IL-6, IL-8and IL-10and BISAP scoring system in the early prediction of AP.This study make up with three parts:(1).Significance of serum IL-6, IL-8, IL-10in the early diagnosis of acute pancreatitis in rats.(2).Retrospective analysis of BISAP scoring system, APACHE II and Ranson score systems in predicting the severity of acute pancreatitis.(3)Clinical value of IL-6combined with BISAP scoring system in predicting the severity acute pancreatitis:a prospective analysis Part one:Significance of serum IL-6, IL-8, and IL-10in the early diagnosis of acute pancreatitis in ratsObjective To evaluate the relationship between the levels of serum IL-6, IL-8, IL-10and the severity of AP in rats.Methods Seventy SD rats were divided into seven groups randomly. Which including the SO groups (sham-operation), AP (acute pancreatitis) groups (12hours,24hours and48hours) and the SAP (severe acute pancreatitis) group (12hours,24hours and48hours);there are10rats in each group. SAP models were induced by intraductal administration of5%sodium taurocholate (STC), The AP models were induced by intraductal administration of2%sodium taurocholate. The pathological changes of pancreas in each group were observed by HE staining; The level of interleukin-6(IL-6), IL-8and IL-10in serum were tested by ELISA; The serum level of amylase in were tested by artificial iodine colorimetry.Results. No pathological changes were seeing in pancreas of rats in SO groups. We can see the pancreatic cell congestion swelling, the pancreatic cells edema and the inflammatory cell infiltration in MAP group under the light microscope. While in the SAP group we can see there were so many inflammatory cell infiltrations, and hemorrhage even punctate or focal necrosis. The differences of serum amylase between the SAP (12hours) and MAP (12hours) should no significance. The differences of serum amylase between the SAP (12hours) and SAP (48hours) should no significance. In the early stage of acute pancreatitis, the concentration of serum IL-6increased earlier, and increases with the increasing severity of the disease, the concentration of serum IL-8increased slower than IL-8, and when pancreatitis reaches to a high certain the its degree began to rise. While the concentration of IL-10along with the aggravation of the severity of pancreatic inflammation increased first and then decreased.Conclusions The levels of IL-6, IL-8, IL-10in the serum changes in the early phase of acute pancreatitis. The level of IL-6in the serum was increased in the early stage of acute pancreatitis and it has the positive correlation with the severity of acute pancreatitis. The elevated levels of IL-8indicate the severity of acute pancreatitis. However the levels of IL-10decrease with the severity increased,IL-6, IL-8and IL-10can be used as the laboratory marker in the early prediction of the prognosis of acute pancreatitis. Part2Retrospective analysis of BISAP scoring system, APACHE II and Ranson score systems in predicting the severity of acute pancreatitisObjective Retrospective analysis of the value of BISAP, APACHE II score, and Ranson score system for predicting the severity of early AP.Methods The medical records of all patients with acute pancreatitis (AP) admitted to Anhui provincial hospital between January1st2009and Dec31st2012were reviewed retrospectively. Severe AP was defined as the persistence of organ failure for more than48hours. The capacity of the BISAP, APACHE-II and Ranson’s score system to predict organ failure, pancreatic necrosis and mortality was evaluated using linear-by-linear association. The predictive accuracy of the BISAP, APACHE-Ⅱ and Ranson score was measured as the area under the receiver operating characteristic curve (AUC).Results Of135patients enrolled in the study,17.7%were classified as having severe AP, and5(3.2%) died, and20were diagnosed as pancreatic necrosis. The AUC for organ failure predicted by BISAP was0.773(95%CI0.675-0.871), APACHE-Ⅱ was0.821(95%CI0.724-0.918) and by Ranson score was0.897(95%CI0.806-0.988). The AUC for PNec predicted by BISAP was0.819(95%CI0.720-0.919), APACHE-Ⅱ0.785(95%CI0.670-0.899) and by Ranson score was0.825(95%CI0.722-0.929). The AUC for mortality predicted by BISAP was0.773(95%CI0.564-0.982), APACHE-Ⅱ0.786(95%CI0.682-0.891) and by Ranson score was0.889(95%CI0.803-0.975).Conclusions Ranson score systems have an advantage over the APACHE II and BISAP score system in predicting the organ failure. There were no differences between the APACHE-Ⅱ,BISAP and Ranson in predicting pancreatic necrosis and mortality in Acute pancreatitis Part3Clinical value of cytokines combined with BISAP scoring system in estimating the severity of acute pancreatitis:a prospective analysisObjective Prospective analysis of the clinical value of IL-6combined with BISAP scoring system in predicting the severity of acute pancreatitisMethods The medical records of all patients with acute pancreatitis (AP) admitted to Anhui provincial hospital between January1st2013and January1st2014were reviewed prospectively. Severe AP was defined as the persistence of organ failure for more than48hours. The Blood samples of AP patients were collecting in the moment of24hours after admission. The capacity of the BISAP, APACHE-Ⅱ, Ranson’s and IL-6combined with BISAP score system to organ failure, pancreatic necrosis and mortality was evaluated using linear-by-linear association. The predictive accuracy of the BISAP, APACHE-Ⅱ and Ranson’s score was measured by creating the ROC curves.Results There are94patients enrolled in the study,51males and average age48.78±18.52years. The course of the disease differs from1hour to24hours with average13.54±10.08h. Of the patients enrolled in the study,21.2%were classified as having severe AP,4(4.2%) died, and14(14.9%). The AUC for organ failure predicted by BISAP, APACHE Ⅱ, Ransons and IL-6combine with BISAP were0.891(95%CI0.819-0.963),0.818(95%CI0.709-0.926),0.916(95%CI0.817-1.000) and0.902(95%CI0.802-0.999). The AUC for PNec predicted by BISAP, APACHE II, Ransons and IL-6combine with BISAP were0.855(95%CI0.742-0.968),0.754(95%CI0.606-0.903),0.875(95%CI0.780-0.971).0.883(95%CI0.744-0.942). The AUC for mortality predicted by BISAP, APACHE II, Ransons and IL-6combine with BISAP were0.786(95%CI0.574-0.985)、0.792(95%CI0.617-0.966),0.834(95%CI0.735-0.979)�'�0.829(95%CI0.709-0.912)o Conclusion:Ranson score system has an advantage over other score system such as the BISAP and APACHE Ⅱ in predicting the organ failure of acute pancreatitis. When predicting the pancreatic necrosis of acute pancreatitis, the IL-6combined with BISAP was the best score system. There were no differences in predicting the mortality of acute pancreatitis between the four score systems.