| Theme |
Serve Acute Pancreatitis -- Prediction of Deterioration and Therapeutic Strategy |
| Title |
Predicting Infection in Severe Acute Pancreatitis Patients |
| Author |
Nobuaki Kawarabayashi |
Department of Surgery I, National Defense Medical College |
| Author |
Kazuo Hatsuse |
Department of Surgery I, National Defense Medical College |
| Author |
Satoshi Ono |
Department of Surgery I, National Defense Medical College |
| Author |
Hiroki Tsujimoto |
Department of Surgery I, National Defense Medical College |
| Author |
Atsushi Matsumoto |
Department of Surgery I, National Defense Medical College |
| Author |
Hidetaka Mochizuki |
Department of Surgery I, National Defense Medical College |
| [ Summary ] |
It is very important to diagnose infected pancreatic necrosis, which is one infectious complication associated with acute pancreatitis and which may determine the clinical course and outcome. We have examined whether to diagnosis the infection of pancreatic necrosis, based on the inflammatory response of monocytes and neutrophils to lipopolysaccharide (LPS), because the bacterial spectrum in infected pancreatic necrosis consists of primarily gram-negative bacteria. CD14 expression on monocytes is analysed with a flowcytometer, as a receptor for LPS and CD11b expression on monocytes and neutrophils are analysed as an activation marker. When patients are exposed to infection by gram-negative bacteria, CD14 expression on monocytes decreases and CD11b expression on monocytes and neutrophils increases. The kinetics of CD14 and CD11b may inform us as to the degree of infection and inflammation. The patient, whose expression of CD14 has declined, while maintaining a high expression of CD11b, despite of an intensive treatment, may be determined to have severely infectious pancreatic necrosis and requires surgical treatment. This method is very useful for determining the degree of infection and when deciding on the indications for surgical treatment of pancreatic necrosis. |