Skip Navigation LinksHome > August 2013 - Volume 47 - Issue 7 > Tumor Necrosis Factor-α Levels Early in Severe Acute Pancrea...
Journal of Clinical Gastroenterology:
doi: 10.1097/MCG.0b013e31828a6cfc
LIVER, PANCREAS AND BILIARY TRACT: Original Articles

Tumor Necrosis Factor-α Levels Early in Severe Acute Pancreatitis: Is There Predictive Value Regarding Severity and Outcome?

Surbatovic, Maja MD, PhD*,†; Radakovic, Sonja MD, PhD†,‡

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Abstract

Goal and Background: One of the most important cytokines in pathogenesis of acute pancreatitis is tumor necrosis factor (TNF)-α. The aim of our study was to determine whether the plasma levels of TNF-α in patients with severe acute pancreatitis (SAP) on admission correlate with severity and outcome of SAP.

Study: Blood samples were obtained from 100 patients with SAP. Patients were divided into 2 groups according to severity: SAP group (n=69) and SAP-induced multiple organ dysfunction syndrome (MODS) group (n=31). Survivors were patients who were alive 90 days after taking the blood sample for cytokine measurement (53/100). Blood sample for cytokine measurement was drawn immediately after admission. TNF-α was measured by commercial ELISA test in plasma.

Results: When comparing SAP group with SAP-induced MODS group, we found that mean values of TNF-α on admission were 191.5-fold lower in group with SAP-induced MODS (P<0.01). When comparing nonsurvivors with survivors, we found that mean values of TNF-α on admission were 63-fold higher in survivors (P<0.01). At cut-off level of 7.95 pg/mL sensitivity was 83.9% and specificity was 72.5%. Patients with TNF-α level lower than 7.95 pg/mL had 3.2-fold higher probability to develop SAP with MODS. At cut-off level of 10.5 pg/mL sensitivity was 83% and specificity was 77.4%. Patients with TNF-α level higher than 10.5 pg/mL had 4.8-fold higher probability to survive.

Conclusions: TNF-α is good predictor of severity and outcome. Low TNF-α concentration in patients with SAP predicts development of MODS and fatal outcome.

© 2013 by Lippincott Williams & Wilkins

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