Changes in the regulation of the immune response in acute necrotizing pancreatitis complicated by multiple organ failure

Abstract

Timely identification of patients with severe acute necrotizing pancreatitis (ANP) is one of the main problems of the modern strategy for its treatment.

Aim: To study the cytokine regulation of the immune response in patients with ANP complicated by multiple organ failure (MOF).

Material and methods: We conducted a prospective cohort study of 22 patients with ANP complicated by MOF who were treated in the clinic during 2014–2020. We studied changes in blood cells expressing clusters CD11a⁺, CD162⁺, CD95⁺, CD16⁺, HLA-DR⁺ molecules, and levels of interleukins IL-2, IL-4, and IL-6. The efficacy of treatment was estimated by MOF duration, the level of postoperative complications, and mortality.

Results: Patients with ANP complicated by MOF exhibited a simultaneous observation of a low level of expression of CD11a⁺ and CD162⁺ on immunocompetent cells, along with a 2-fold lower content of CD95⁺ cells. This contributed to a decrease in the concentration of IL-6, accompanied by a slight increase in IL-4. A permanent decrease in the content of CD11a⁺-, CD162⁺- and CD95⁺-leukocytes simultaneously with a decrease in the concentration of IL-4 and an excessive increase in the levels of IL-2 and IL-6 was associated with a negative course of the disease.

Conclusion: The imbalance in the cytokine regulation of the immune response occurs in patients with ANP complicated by MOF. Patients with an unfavorable disease course in the absence of IL-4 exhibit a progressive and excessive increase in plasma concentrations of IL-2 and IL-6.