Changes in plasma levels of acute phase proteins in pancreatitis

The objective of our study was to determine whether the changes in the plasma levels of C-reactive protein, haptoglobin, transferrin, and alpha 1-acid glycoprotein (orosomucoid) in acute pancreatitis patients examined on days 1, 3, 5, 7, 9, and 14 after their admission to hospital can be used to assess the course and determine the severity of the disease, and to discriminate edematous from necrotizing pancreatitis. The study included 18 patients with mild pancreatitis and 20 patients with severe pancreatitis. Pancreatitis was classified as mild or severe according to Ranson and the Acute Physiology and Chronic Health Evaluation (APACHE) II scores. Acute phase proteins were determined using the immunoturbidometric assay. The C-reactive protein in the mild pancreatitis patients was six-fold higher at admission, then gradually increased for 5 days and started to drop. In the severe clinical forms of pancreatitis the C-reactive protein had significantly high values throughout the whole time of study retaining this high level to day 14; these elevated levels correlated with the persistent severe general state of the patients and the extent of necrosis in the pancreas. The changes in the haptoglobin and transferrin levels were not significant. Orosomucoid level in mild pancreatitis cases remained constant whereas it was elevated and continuously above the reference values in severe pancreatitis.

C-reactive protein level changes significantly in patients with acute pancreatitis; it is in the range of 100-120 mg/l in the mild forms of the disease and between 120 and 360 mg/l in the severe pancreatitis. This renders it a valuable indicator for the discrimination of edematous from necrotizing acute pancreatitis.