Interleukin-6: An Early Predictive Marker for Severity of Acute Pancreatitis

According to the Atlanta guidelines, a case of severe acute pancreatitis (SAP) is defined as one with features of acute pancreatitis and with persistent organ failure lasting beyond 48 h. This essentially makes the diagnosis of SAP a retrospective one, by which time a critical window for early intervention may be lost. To enable the early prediction of clinical outcomes of pancreatitis, multiple scoring systems such as Ranson, The Ranson score uses 11 variables, collected at admission and 48 h after admission. The Glasgow score includes nine variables. Both have predictive values of 71%-88%. The APACHE score is derived from 12 variables and can be repeated at any time during the clinical course of the patient. e existing scoring systems require a large number of clinical and biochemical parameters, making them cumbersome to perform. Hence, a search for a single marker which might allow for earlier, easier, and more accurate prediction of SAP still continues, especially in the face of emerging treatment modalities whose efficacy hinges on the early intervention. Few randomized studies have shown that patients with SAP benefit from early, aggressive prophylactic antibiotic therapy, as opposed to mild pancreatitis which is usually self-limited and resolves with basic fluid and supportive management. Early endoscopic sphincterotomy (within 24-48 h of admission) is indicated in patients with severe acute gallstone-induced pancreatitis. Early treatment with protease inhibitors has been shown to be of value in a meta-analysis If the development of SAP can be predicted before the development of the multiple organ dysfunction syndrome, the early initiation of aggressive therapy might prevent its development. Emerging therapies such as cytokine inhibitors are targeting mediators of Background and Aims: Interleukin (IL)-6, IL-8, IL-10, and C-reactive protein (CRP) have been evaluated for predicting outcomes of acute pancreatitis. However, there is considerable variation in their performance among different studies. We evaluate their accuracy in predicting progression to severe pancreatitis. Materials and Methods: Serum IL-6, IL-8, IL-10, and CRP levels were measured within 24 h of admission in forty patients of clinically predicted severe acute pancreatitis (SAP). Persistent organ failure (>48 h) defined SAP. The performance of inflammatory markers was evaluated in predicting the progression of pancreatitis. Results: IL-6 28.90 pg/mL had a sensitivity of 62.86%, specificity of 80%, positive predictive value (PPV) of 95.65%, LR+ of 3.1429, LR-of 0.4643, and diagnostic odds ratio (DOR) of 6.7692; IL-8 88.70 pg/mL had a sensitivity of 60%, specificity of 80%, PPV of 95.45%, LR+ of 3.000, LR-of 0.5000, and DOR of 6.000; IL-10 5.70 pg/mL had DOR of 0.2647, sensitivity of 51.43%, specificity of 20%, PPV of 81.82%, LR+ of 0.6429, and LR-of 2.4286. CRP 110.00 mg/L had DOR of 2.3636, sensitivity of 37.14%, specificity of 80%, PPV of 92.86%, LR+ of 1.8571, and LR of 0.7857. Conclusions: IL-6 28.90 pg/mL, measured within 48 h of onset is the best among the tested biomarkers in this study for predicting the progression to severe pancreatitis.