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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†,‡

Journal of Clinical Gastroenterology: August 2013 - Volume 47 - Issue 7 - p 637–643
doi: 10.1097/MCG.0b013e31828a6cfc

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.

*Clinic of Anesthesiology and Intensive Therapy, Military Medical Academy

Faculty of Medicine of the Military Medical Academy, University of Defense

Sector of Preventive Medicine, Military Medical Academy, Belgrade, Serbia

The authors declare that they have nothing to disclose.

Reprints: Maja Surbatovic, MD, PhD, Clinic of Anesthesiology and Intensive Therapy, Military Medical Academy, Crnotravska 17, Belgrade 11000, Serbia (e-mail:

Received May 24, 2012

Accepted January 29, 2013

© 2013 by Lippincott Williams & Wilkins