Immune suppression plays an important role in the pathogenesis of acute pancreatitis. Monocyte expression of HLA (human leucocyte antigen)-DR, a cellular marker of immune suppression, was determined in relation to the development of organ dysfunction in patients with acute pancreatitis. A total of 310 consecutive patients with acute pancreatitis, admitted to a university hospital within 72 h of pain onset, were studied; 194 (63%) had mild disease (group I), 87 (28%) had severe disease without organ dysfunction (group II), and 29 (9%) had severe disease with organ dysfunction (group III). HLA-DR expression, defined both as the proportion of monocytes that were HLA-DR-positive and as monocyte HLA-DR fluorescence intensity, was determined at admission, using whole-blood flow cytometry. Of the patients in group III, 13 (45%) developed organ dysfunction within 24 h of admission. The proportion of HLA-DR-positive monocytes and monocyte HLA-DR density were both related to the severity of pancreatitis (P<0.001 for linear trend). In predicting organ dysfunction, the sensitivity, specificity and positive-likelihood ratio for the proportion of HLA-DR-positive monocytes were 83% [95% CI (confidence interval) 64–94%], 72% (67–77%) and 3.0 respectively, and for monocyte HLA-DR density the respective values were 69% (49–85%), 84% (79–88%) and 4.3. In conclusion, monocyte HLA-DR expression predicts the development of organ dysfunction that occurs early in patients with acute pancreatitis.
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October 2003
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Research Article|
October 01 2003
Decreased HLA (human leucocyte antigen)-DR expression on peripheral blood monocytes predicts the development of organ failure in patients with acute pancreatitis
Panu MENTULA;
*Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, Helsinki, Finland
Correspondence: Dr Panu Mentula, MD, Department of Bacteriology and Immunology, Haartmaninkatu 3, PL 21, 00014 University of Helsinki, Helsinki, Finland (e-mail [email protected]).
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Marja-Leena KYLÄNPÄÄ-BÄCK;
Marja-Leena KYLÄNPÄÄ-BÄCK
†Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland
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Esko KEMPPAINEN;
Esko KEMPPAINEN
†Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland
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Annika TAKALA;
Annika TAKALA
‡Department of Anesthesia and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland
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Sten-Erik JANSSON;
Sten-Erik JANSSON
§Department of Clinical Chemistry, Helsinki University Central Hospital, Helsinki, Finland
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Hannu KAUTIAINEN;
Hannu KAUTIAINEN
║The Rheumatism Foundation Hospital, Heinola, Finland
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Pauli PUOLAKKAINEN;
Pauli PUOLAKKAINEN
†Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland
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Reijo HAAPIAINEN;
Reijo HAAPIAINEN
†Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland
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Heikki REPO
Heikki REPO
¶Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
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Publisher: Portland Press Ltd
Received:
February 05 2003
Revision Received:
May 19 2003
Accepted:
June 02 2003
Accepted Manuscript online:
June 02 2003
Online ISSN: 1470-8736
Print ISSN: 0143-5221
© 2003 The Biochemical Society
2003
Clin Sci (Lond) (2003) 105 (4): 409–417.
Article history
Received:
February 05 2003
Revision Received:
May 19 2003
Accepted:
June 02 2003
Accepted Manuscript online:
June 02 2003
Citation
Panu MENTULA, Marja-Leena KYLÄNPÄÄ-BÄCK, Esko KEMPPAINEN, Annika TAKALA, Sten-Erik JANSSON, Hannu KAUTIAINEN, Pauli PUOLAKKAINEN, Reijo HAAPIAINEN, Heikki REPO; Decreased HLA (human leucocyte antigen)-DR expression on peripheral blood monocytes predicts the development of organ failure in patients with acute pancreatitis. Clin Sci (Lond) 1 October 2003; 105 (4): 409–417. doi: https://doi.org/10.1042/CS20030058
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