Circulating Lymphocyte Subsets in Human Acute Pancreatitis

Abstract

We investigated peripheral lymphocyte subsets in 34 consecutive acute pancreatitis patients (21 males, 13 females; mean age, 57 years; range, 16-85 years) studied within 48 h of pain onset and for 5 consecutive days to understand better the immunological response during the course of the disease. The diagnosis was based on characteristic abdominal pain associated with a twofold increase in serum lipase and confirmed by imaging techniques in all patients. Acute pancreatitis was of biliary origin in 25 patients, due to alcohol abuse in 5, due to pancreas divisum in 1 , and of unknown origin in 3. Fifteen patients had severe illness and 19 had mild disease. In all patients, total lymphocyte and lymphocyte subset counts were carried out on admission, as well as on the third and fifth day of hospitalization, using a flow cytometric analysis. Twenty-three patients (13 with severe illness and 10 with mild disease) also had a repeat count 1 month after recovery. Twenty-five healthy subjects and 27 patients with nonpancreatic acute abdomen comparable for sex and age were studied as controls. On the first day of the study, the leukocyte number was significantly higher in patients with acute pancreatitis and in those with nonpancreatic acute abdomen with respect to healthy subjects, whereas the number of total and CD4+, CD8+, CD3+DR-, and CD3-DRf lymphocytes was significantly lower in acute pancreatitis patients than in healthy subjects or in patients with nonpancreatic acute abdomen. These subset counts persisted on the third and fifth days of the study. Patients with nonpancreatic acute abdomen and healthy subjects had similar values of total and lymphocyte subsets. The patients with acute pancreatitis studied 1 month after complete recovery had numbers of leukocytes, total lymphocytes, and CD4', CD8+, CD3+DR-, and CD3-DR+ lymphocytes similar to those in healthy subjects. Regarding CD3 +DRf lymphocytes, the count in acute pancreatitis patients studied within the first 5 days of hospital admission was similar to that in healthy subjects, but 1 month after complete recovery it was significantly higher in the pancreatitis patients. CD4+ and CD3 +DR-lymphocyte counts were significantly lower in patients with severe acute pancreatitis than in patients with mild disease from the third day of illness onward. The CD4+-T cell difference was still present 1 month later. The number of total lymphocytes was significantly lower in patients with severe illness relative to those with mild pancreatitis on the fifth day of hospitalization. Results demonstrate that in early phases of acute pancreatitis there was a significant decrease in the number of total lymphocytes and lymphocyte subset counts relative to controls. These counts returned to normal with resolution of the illness.

Neutrophil-Lymphocyte Ratio as a Predictor of Adverse outcomes of Acute Pancreatitis

“…In contrast, the lymphocytic immune response occurs later and its main function is to mediate and resolve the preceding nonspecific inflammatory process. Prior studies have shown an association between lower peripheral lymphocyte counts and the severity of cases of acute pancreatitis [31,32,33]. Such decline in lymphocyte count in acute pancreatitis was attributed to apoptosis and was also associated with lymphocyte dysfunction [34,35].…”

Significant elevation of serum interleukin-18 levels in patients with acute pancreatitis

“…[1][2][3] Immunological impairment in the early phase may be linked to increased susceptibility to subsequent infection and the development of septic complications. Several investigators have reported the reduction in peripheral lymphocyte count, [4][5][6] and it may reflect the immunological impairment. Particularly, Curley et al reported a significant decrease in the proportion of helper T cells in severe acute pancreatitis.…”

Immunosuppression in patients with severe acute pancreatitis

“…1,2 Immunologic impairment in the early phase may be linked to the increased susceptibility to subsequent infection and the development of septic complications. Several investigators have reported a reduction of the peripheral lymphocyte count in acute pancreatitis, [3][4][5][6][7] which may indicate immunologic impairment. Curley et al 4 reported a significant decrease in the proportion of CD4-positive lymphocytes (T-helper cells) in SAP.…”

“…Recent reports have demonstrated a significant decrease in CD4-and CD8-positive lymphocytes in SAP. [5][6][7] However, the relationship between lymphocyte reduction and subsequent infection has not been investigated.…”