PR Farrell et al. J Pediatr 2021; 238: 33-41. Open Access: Cytokine Profile Elevations on Admission Can Determine Risks of Severe Acute Pancreatitis in Children
Methods: In this single center pediatric study, interleukin 6 (IL -6), monocyte chemotactic protein-1 (MCP-1) and CRP were obtained within 48 hours of admission in 66 subjects (20 controls, 36 with mild acute pancreatitis (AP), and 10 with severe AP) in a derivation cohort. and then in a validation cohort with 35 subjects (10 controls, 19 mild AP and 6 severe AP)
- In both the derivation and vaildation cohorts, IL-6 (P = 0.02, P= 0.02 respectively) and MCP-1 (P= 0.02, P = .007) were found to differentiate mild acute pancreatitis from severe acute pancreatitis.
- CRP values were obtained from 53 of the subjects, revealing a strong association between elevated CRP values and progression to severe disease (P < .0001). CRP were stratifed into 3 distinct groups, <0.4 mg/dL, 0.4-2.5 mg/dL, and >2.5 mg/dL
The discussion notes a few points:
- “BUN as part of a standard initial clinical biochemical evaluation on admission, as well as the response of the patient’s BUN to fluid resuscitation can help predict disease severity with high specificity and a high negative predictive value which can help to determine those patients least likely to progress to severe disease”
- “There is adult literature showing the benefit of placing patients at highest risk of progression to severe disease on Cox-2 inhibitors and monitoring, among other measures, the response of IL-6. Patients who received the investigational drug had significantly lower levels of IL-6, and the therapy was associated with an almost 50% reduction in the progression of patients to severe disease.”
My take: In clinical practice, both elevated CRP and BUN are associated with a higher risk of progression to severe pancreatitis. The reason why I was interested in this study was the potential for targeting IL-6 to improve outcomes.
Related blog posts:
- More Data Supporting Lactated Ringers for Acute Pancreatitis
- Pediatric Pancreatitis -Working Group Nutritional Recommendations
- Consensus Pancreatitis Recommendations
- Acute Pancreatitis: NASPGHAN Clinical Report.
- Acute Pancreatitis Review (2016)
- For the pediatric pancreatologists
- Pancreatitis Update (part 1) | gutsandgrowth 2017
- Pancreatitis Update (part 2) 2017
- Changing Practice Patterns with Pediatric Pancreatitis | gutsandgrowth