IL-6, IL-10 and TNFα do not improve early detection of post-endoscopic retrograde cholangiopancreatography acute pancreatitis: a prospective cohort study

Abstract

The most reliable indicators for post-ERCP acute pancreatitis are elevated amylase levels and abdominal pain 24 hours after ERCP. As ERCP is often performed on an outpatient basis, earlier diagnosis is important. We aimed to identify early predictors of post-ERCP pancreatitis. We prospectively analyzed IL-6, IL-10, TNFα, CRP, amylase and lipase before and 4 hours after ERCP, and studied their association with abdominal pain. We included 510 patients. Post-ERCP pancreatitis occurred in 36 patients (7.1%). IL-6, IL-10, TNFα and CRP were not associated with post-ERCP pancreatitis. Levels of amylase and lipase were higher in patients with pancreatitis (522 U/L and 1808 U/L vs. 78 U/L and 61 U/L, respectively; p < 0.001). A cut-off of 218 U/L for amylase (x2.2 ULN) and 355 U/L for lipase (x6 ULN) had a negative predictive value of 99.2% and 99.5%, respectively. Amylase and lipase present a good correlation (Pearson coefficient 0.912). Among 342 (67.1%) patients without abdominal pain at 4 hours, post-ERCP pancreatitis was diagnosed in 8 (2.3%). Only 4 of these patients presented amylase or lipase > 3 ULN. Amylase and lipase were the only markers of post-ERCP pancreatitis 4 hours after the procedure.

Elevated amylase in plasma represents an adverse prognostic marker in patients with metastatic pancreatic cancer

“…This is especially significant as determining blood-based marker is a non-invasive and gentle method towards cancer patients. The enzymes addressed in this study are commonly tested for assessment in suspected acute pancreatitis but their significance with respect to cancer patients is hardly considered [ 12 ].…”

The Initial Course of IL1β, IL-6, IL-8, IL-10, IL-12, IFN-γ and TNF-α with Regard to Severity Grade in Acute Pancreatitis

“…In accordance with previous reports, the present study shows a raise in IL-1β during the first hours after onset of disease, with subsequent releases of IL-6, IL-8 and the anti-inflammatory IL-10 [ 9 , 13 ]. However, clinical investigations on the early (<48 h after onset of pain) development of these biomarkers are deficient with only a few studies published [ 12 , 24 , 27 , 28 ]. Additionally, exact time interval from onset of pain to sample collection was rarely reported and thus not included in analysis [ 6 , 29 ].…”

Utilidad de la amilasa y la lipasa séricas como predictores de gravedad en la pancreatitis poscolangiopancreatografía retrógrada endoscópica

“…El porcentaje de pacientes con pancreatitis sin dolor abdominal es bajo: el 2.3% 11 . Encontramos que la presencia de dolor abdominal es altamente sugestiva de diagnóstico de PPCPRE, pero observamos que se llega a presentar en al menos uno de cada cinco pacientes sometidos a CPRE que no desarrollan pancreatitis.…”

“…Solo hay algunos estudios específicamente en pacientes sometidos a CPRE que evalúan la utilidad de la determinación de la amilasa y la lipasa séricas para predecir la gravedad de la pancreatitis 2,6,[10][11][12] , los cuales muestran que las elevaciones de sus cifras se correlacionan con la presencia de formas graves de pancreatitis y pueden emplearse como predictores; sin embargo, las cifras de corte, los criterios de clasificación de gravedad y el rendimiento diagnóstico difieren.…”