Lipopolysaccharide binding protein in acute pancreatitis

Objective: To assess the expression of plasma lipopolysaccharide binding protein (LBP) concentrations and its relationship to markers of the systemic inflammatory response syndrome during acute pancreatitis. Design: A prospective study, Setting: General surgical units of university teaching hospitals in the Belfast area. Patients: The study included 18 patients admitted with established diagnosis of acute pancreatitis on the basis of elevated serum amylase or by contrast radiology, Patients were retrospectively stratified using the Modified Glasgow Criteria into severe (n = 7) and mild (n = 11) disease. Interventions and Measurements: Blood samples were obtained at admission (day 1) and for a further 3 days for the measurement of LBP, G-reactive protein (CRP), tumor necrosis factor, and interleukin (IL)-6, Acute Physiology and Chronic Health Evaluation (APACHE) II scores were calculated on day 1 and day 2, Main Results: LBP and CRP concentrations were significantly increased from healthy control values in acute pancreatitis patients at presentation, In the mild group LBP, CRP and IL-6 concentrations remained relatively constant throughout the study period. By comparison, severe acute pancreatitis was associated with significantly higher LBP concentrations and a marked systemic inflammatory response as evidenced by increased CRP, IL-6, and APACHE II scores. The rise in LBP occurred after the observed increase of these markers. Significant correlations were found among CRP and LBP, IL-6 and LBP, and IL-6 and APACHE II scores. There were no fatalities in the mild group, whereas four of the seven patients with severe disease died. Conclusions: LBP was significantly raised in patients with severe acute pancreatitis but would seem to be of limited use in predicting disease severity. This acute phase protein may have a role in the progression of systemic complications associated with acute pancreatitis. Further clinical studies are warranted.