Clinical usefulness of polymorphonuclear elastase in predicting the severity of acute pancreatitis: Results of a multicentre study

Abstract

The usefulness and clinical applicability of quantitative plasma polymorphonuclear elastase determinations in the diagnosis of the severity of acute pancreatitis was analysed in a multicentre study and was compared with the usual prognostic systems of Ranson and Osborne et al. The study comprised 182 patients, 154 with a mild episode of acute pancreatitis and 28 with a severe episode, defined by the development of major complications or a fatal outcome. In the severe cases neutrophilic elastase reached significantly higher values than in mild cases (P less than 0.001) by the time the patient was admitted (2-12 h after the onset of the disease), reflecting considerable leucocyte activation. The sensitivity and specificity of this test are therefore greater than 90 per cent, with a positive severity predictive value of almost 80 per cent at the time of admission and 97 per cent after 24 h, and a negative predictive value of approximately 98 per cent. In addition to requiring 48 h for evaluation, the usual prognostic systems show a sensitivity of 77-85 per cent, a specificity of 70-77 per cent, a positive predictive value of 40-48 per cent, and a negative predictive value of 92-95 per cent, clearly lower than those obtained with leucocyte elastase. Polymorphonuclear elastase is therefore a very early and reliable marker in the diagnosis of the severity of acute pancreatitis, in addition to being easily adaptable to the routine of any hospital laboratory.

Serum amyloid A is a better early predictor of severity than C-reactive protein in acute pancreatitis

“…A single marker would have considerable attraction for routine clinical practice. Many single markers have been assessed, including serum interleukin (IL) 8 12 , IL-6 13 , procalcitonin 12,14 , tumour necrosis factor (TNF) 15 , phospholipase A 2 16 , C-reactive protein (CRP) 16 , trypsin 2 and a 1 -antitrypsin complex 17 , anionic trypsinogen 18 , and the activation peptides of carboxypeptidase B 18 and cationic trypsinogen (TAP) 19 . Of these, only CRP is in routine clinical use, but it is predictive only 48± 72 h after the onset of symptoms, with an accuracy of around 70 per cent 12,13,15,16,19 .…”

Induction of apoptotic cell death by pancreatitis‐associated ascitic fluid in Madin‐Darby canine kidney cells

“…For instance, TGF-fl, one of the cytokines released from various cells or tissues including activated macrophages, was reported to induce apoptosis on MDCK cells [24]. On the other hand, the cytokines and their derivatives, which were released from the activated macrophages or lymphocytes, and elastase released by polymorphonuclear leukocytes play important roles in the induction of organ failure in acute pancreatitis [33][34][35]. Considering these lines of evidence, it is highly possible that the apoptosis-inducing activity in PAAF on MDCK cells is via cytokine(s) or their derivatives.…”

Evaluation of serum L-FABP levels in patients with acute pancreatitis

“…A number of biochemical markers have been used in the diagnosis of acute pancreatitis. [1][2][3] Several of these markers have been documented to be present at increased concentrations in the plasma of patients with acute pancreatitis. …”