High at Admission Serum Interleukin-6 and Cell Free DNA as Predictors for Severity and Outcome of Acute Pancreatitis Patients
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Objectives: To evaluate outcome of therapeutic interventions for cases of acute pancreatitis (AP) and to determine diagnostic yield and predictability of at admission estimation of serum C-reactive protein (CRP), interleukin (IL)-6 and cell free DNA (cfDNA) for such outcome. Patients & Methods: The study included 67 AP patients. Ranson Criteria scoring (RS) was used to assess AP severity as mild acute pancreatitis (MAP) (RS=C points) and sever acute pancreatitis (SAP) (RS=>3 points). Contrast enhanced CT (CECT) was performed 6-10 days after admission and Balthazar's CT severity index (CTSI) was used to strati& the severity. Acute Physiology and Chronic Health Evaluation (APACHE II) score was used to assess the impact of AP on general condition and to help surgical decision making. Intevention policies included conservative treatment for patients with APACHE II score of >10 and surgical intervention either early (within 2 weeks) or late (after 2 weeks)according to the indications. At admission venous blood samples were obtained for estimation of serum CRP, IL-6 and cfDNA. Survival rate was defined as the primary outcome. Results: According to Ranson's criteria 40 patients had MAP and 27 patients had SAP. According to CTSI, 41 patients had 0-3 score, 20 patients had 4-6 score and 6 patients had score of >6. According to APACH II scoring, 23 patients had a score of >10. In conservative treatment group, mortality rate (MR) was 13%, while was 18.2% in surgical intervention group with non-significant difference. In early surgical intervention group, MR was 17.6% and 15.4% in the late group with non-significant difference. At admission serum levels of the three parameters were significantly higher in SAP than in MAP cases. ROC defined at admission serum level of cfDNA as the most significant early predictor and CTSI as the most significantly specific diagnostic procedure for SAP. High serum IL-6 and cfDNA could predict mortality with high specificity. Conclusion: High at admission serum cfDNA and IL-6 levels could be used as early predictors for severity of AP and its survival rates. Therapeutic intervention modalities showed non-significant difference in MR. Proper case selection for early surgical intervention improves outcome without deleterious effect on survival rate.