Cytokines and myeloperoxidase as markers of purulent-septic complications of acute pancreatitis

Abstract Background Purulent-septic complications often determine the outcome of severe acute pancreatitis. Unfortunately, there are no useful markers that can predict the contamination of necrotic foci. Methods Thirty-eight patients with severe pancreatitis were treated. The plasma levels of interleukin (IL) 1, IL-6, IL-8 and myeloperoxidase (MPO) were studied in all patients on days 1, 3, 7, 14 and 21 after the onset of acute pancreatitis. Results Raised levels of all inflammatory mediators were observed in all patients on the first day. A gradual decrease in cytokine and MPO levels was noted in patients with sterile necrosis and a favourable course of acute pancreatitis (17 patients). Contamination of the necrotic foci was accompanied by a rise in IL-8 (140·0 pg ml−1 or more) and MPO (11·0 nmol ml−1 or more) levels, which preceded the clinical manifestation of purulent complications. These results were confirmed by ultrasonographically guided aspiration. Two types of purulent-septic complications were identified: local and disseminating. Local purulent-septic complications (nine patients) were characterized by a moderate increase in cytokine levels and were associated with a good prognosis. The disseminating purulent-septic complications group (12 patients) was characterized by highest levels of proinflammatory cytokines, significant multiple organ failure and a poor prognosis. Eight patients with widespread purulent-septic complications died. Conclusion IL-8 and MPO plasma levels are valuable markers of infected necrosis in acute pancreatitis.