Advertisement

Serum lipase, C-reactive protein, and interleukin-6 levels in ERCP-induced pancreatitis

      Abstract

      Background: C-reactive protein (CRP) and interleukin-6 (IL-6) are elevated in acute pancreatitis. Limited studies have evaluated their role in ERCP-induced pancreatitis. The aim of this study was to assess the role of serum lipase, CRP, and IL-6 in ERCP-induced pancreatitis. Methods: Eighty-five patients (62 women, 23 men; mean age 43 years; range 16-85 years) who underwent ERCP were entered in a prospective trial. ERCP-induced pancreatitis was classified as mild, moderate, or severe. Serum levels of lipase, CRP, and IL-6 were measured before ERCP and at 12 to 24 hours and 36 to 48 hours after ERCP. Results: Mild, moderate, and severe pancreatitis occurred, respectively, in 9, 7, and 4 patients after ERCP. There were significant differences in levels of CRP and IL-6 but not lipase for patients with mild versus moderate and moderate versus severe pancreatitis. The mean CRP levels (mg/dL) at 12 to 24 hours were 0.98 ± 0.24 in mild pancreatitis, 3.89 ± 0.32 in moderate pancreatitis, and 12.0 ± 1.60 in severe pancreatitis. The levels, respectively, at 36 to 48 hours were 1.60 ± 0.31, 7.60 ± 0.74, and 25.0 ± 2.9. The mean IL-6 levels (pg/mL) at 12 to 24 hours were 16.6 ± 2.06 in mild pancreatitis, 73.0 ± 15.60 in moderate pancreatitis, and 235.5 ± 26.31 in severe pancreatitis. The levels at 36 to 48 hours were, respectively, 18.92 ± 3.28, 100.17 ± 11.56, and 438.2 ± 71.50. Conclusions: Serum CRP and IL-6 levels may be useful early markers for predicting the severity of ERCP-induced pancreatitis. (Gastrointest Endosc 2001;54:435-40.)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sherman S
        • Lehman GA.
        ERCP and endoscopic sphincterotomy.
        Pancreas. 1991; 6: 350-367
        • Goris RJA.
        Mediators of multiple organ failure.
        Intensive care medicine. 1990; 16: 192-196
        • Gross V
        • Leser HG
        • Heinisch A
        • Scholmerich J.
        Inflammatory mediators, and cytokines—new aspects of pathophysiology and assessment of severity of acute pancreatitis.
        Hepatogastroenterol. 1993; 40: 522-530
        • Mayer AD
        • McMacmahon MJ
        • Bowen M
        • Cooper EH.
        C-reactive protein: an aid to assessment and monitoring of acute pancreatitis.
        J Clin Pathol. 1989; 37: 207-211
        • Puolakkainen P
        • Valtonen V
        • Paananen A
        • Schroder T.
        C-reactive protein and serum phospholipase A2 in the assessment of severity of acute pancreatitis.
        Gut. 1987; 28: 764-771
        • Wilson C
        • Heads A
        • Shenkin A
        • Imrie CW.
        C-reactive protein, antiproteases, and complement factor as objective markers of severity in acute pancreatitis.
        Br J Surg. 1989; 96: 1264-1267
        • Berney T
        • Gasche Y
        • Robert J
        • Jenny A
        • Mensi N
        • Grau G
        • et al.
        Serum profiles of interleukin-6, interleukin-8 and interleukin-10 in patients with severe and mild acute pancreatitis.
        Pancreas. 1999; 18: 371-377
        • Viedma IA
        • Mateo MP
        • Dominguez JE
        • Carballo F.
        Role of interleukin-6 in acute pancreatitis. Comparison with C-reactive protein and phospholipase A2.
        Gut. 1992; 33: 1264-1267
        • Health DI
        • Cruikshank A
        • Jehnali 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. 1993; 34: 41-45
        • Gross V
        • Andressen R
        • Leser HG.
        Interleukin-8 and neutrophil activation in acute pancreatitis.
        European J Clin Investigation. 1992; 22: 200-203
        • Büchler M
        • Malfertheiner P
        • Schddlich H
        • Nevalainen IJ
        • Freiss H
        • Beger HG.
        Role of phospholipase A2 in human acute pancreatitis.
        Gastroenterology. 1989; 97: 1521-1526
        • Gross V
        • Schvlmerich J
        • Leser HG
        • Salm R
        • Lausen M
        • Ruckauer K
        • et al.
        Granulocyte elastase in assessment of severity of acute pancreatitis. Comparison with acute phase proteins C-reactive protein, alpha-1-antitrypsin, and protease inhibitor alpha-2-macroglobuin.
        Dig Dis Sci. 1990; 35: 97-105
        • Uhl W
        • Büchler M
        • Malfertheiner P
        • Martini M
        • Beger HG.
        PMN elastase in comparison with CRP, antiproteases, and LDH as indicators of necrosis in human acute pancreatitis.
        Pancreas. 1991; 6: 253-259
        • Kivsaari L.
        Contrast absorption and pancreatic inflammation following experimental ERCP.
        Investigational Radiology. 1979; 14: 493-497
        • Freeman ML
        • Nelson DB
        • Sherman S
        • Haber GB
        • Herman ME
        • Dorsher PJ
        • et al.
        Complications of endoscopic biliary sphincterotomy.
        N Engl J Med. 1996; 335: 909-918
        • Podolsky I
        • Haber GB
        • Kortan P
        • Gray R.
        Risk factors of pancreatitis following ERCP: a prospective study.
        Am J Gastroenterol. 1988; 83 ([abstract]): A1072
        • Cotton PB
        • Lehman G
        • Vennes J
        • Geenen JE
        • Russell RC.
        • Meyers WC.
        • et al.
        Endoscopic sphincterotomy complications, and their management. An attempt at consensus.
        Gastrointest Endosc. 1991; 37: 383-393
        • Ranson JHC
        • Rifkind KM
        • Roses DF
        • Fink SD
        • Eng K
        • Spencer FC.
        Prognostic signs and the role of operative management in acute pancreatitis.
        Surg Gynecol Obstetrics. 1974; 139: 69-81
        • Clavien PA
        • Hauser H
        • Meyer P.
        • Rohner A.
        Value of contrast enhanced computerized tomography in the early diagnosis and prognosis of acute pancreatitis.
        Am J Surg. 1988; 155: 457-466
        • Wilson C
        • Heath DL
        • Imrie CW.
        Prediction of outcome in acute pancreatitis. A comparative study of APACHE. clinical assessment, and multiple scoring systems.
        Br J Surg. 1990; 77: 1260-1264
        • Bank S
        • Wise L
        • Gersten M.
        Risk factors in acute pancreatitis.
        Am J Gastroenterol. 1983; 73: 637-640
        • Agarwal N
        • Pitchumoni CS.
        Simplified prognostic criteria in acute pancreatitis.
        Pancreas. 1986; 1: 69-73
        • Heinrich PC
        • Castell JV
        • Andus T.
        Interleukin-6 and the acute phase response.
        Biochem J. 1990; 265: 621-636
        • Shenkin A
        • Fraser WD
        • Series J
        • Winstanley EP
        • McCartney AC
        • Burns HJG
        • et al.
        The serum interleukin-6 response to elective surgery.
        Lymphokine Res. 1989; 8: 123-127
        • Nijisten MW
        • DeGroot ER
        • Ten-Duis HJ
        • Klesen HJ
        • Hack CE
        • Aarden LA.
        Serum levels of interleukin-6 and acute phase response.
        Lancet. 1987; 2 ([letter]): 921
        • Helfgott DC
        • Tatter SB
        • Santhanam U
        • Clarick RH
        • Bhardwaj N
        • May LT
        • et al.
        Multiple forms of IFN-b and IL-6 in serum and body fluids during acute bacterial infections.
        J Immunol. 1989; 142: 948-953
        • Van Oers MH
        • Van Der Heyden AA
        • Arden LA.
        Interleukin-6 in serum and urine levels of renal transplant recipients.
        Clin Exp Immunol. 1988; 71: 314-319
        • Gross V
        • Andes T.
        Cytokines and synthesis of acute phase proteins.
        in: Inflammatory bowel diseases. Progress in basic research and clinical implications. : Kluwer Academic, Dordrecht, The Netherlands1991: 164-170
        • Pezzilli R
        • Miniero R
        • Cappelletti O
        • Barakat B.
        Serum interleukin 6 in the prognosis of acute biliary pancreatitis.
        Ital J Gastroenterol Hepatol. 1998; 30: 291-294
        • Pezzilli R
        • Morselli-Labate AM
        • Miniero R
        • Barakat B
        • Fiocchi M
        • Cappelletti O.
        Simultaneous serum assays of lipase and interleukin 6 for early diagnosis and prognosis of acute pancreatitis.
        Clin Chem. 1999; 45: 1762-1767
        • Chen CC
        • Wang SS
        • Lee FY
        • Chang FY
        • Lee SD.
        Proinflammatory cytokines in early assessment of the prognosis of acute pancreatitis.
        Am J Gastroenterol. 1999; 94: 213-218
        • Messman H
        • Vogt W
        • Lock G
        • Heinisch A
        • Fiirstenberg AV
        • Leser HG
        • et al.
        Post ERCP pancreatitis as a model for cytokine induced acute phase in acute pancreatitis.
        Gut. 1997; 40: 80-85
        • Oezcueruemez-Porsch M
        • Kunz D
        • Hardt PD
        • Fadgyas T
        • Kress O
        • Schulz HU
        • et al.
        Diagnostic relevance of interleukin pattern, acute-phase proteins, and procalcitomn in early phase of post-ERCP pancreatitis.
        Dig Dis Sci. 1998; 43: 1763-1769
        • Gottleib K
        • Sherman S.
        ERCP and endoscopic biliary sphincterotomy induced pancreatitis.
        Gastrointest Endosc Clin N Am. 1998; 8: 87-114
        • Sherman S
        • Ruffolot A
        • Hawes RH.
        Complications of endoscopic sphincterotomy. A prospective series with emphasis on the increased risk associated with sphincter of Oddi dysfunction and non-dilated bile ducts.
        Gastroenterology. 1999; 101: 1068-1075
        • Denham W
        • Norman J.
        The potential role of therapeutic cytokine manipulation in acute pancreatitis.
        Surg Clin N Am. 1999; 79: 767-781