Endotoxaemia and circulating tumour necrosis factor are important prognostic factors in severe sepsis and are implicated in the pathogenesis of septic shock. Because clinical and pathological features in acute pancreatitis are similar to septic shock this study sought to determine whether endotoxin and tumour necrosis factor were prognostic factors in 38 patients with prognostically severe acute pancreatitis. Endotoxaemia, present in 19/37 (51%) patients on day 1, was more common in nonsurvivors than survivors (10/11, 91% v 9/26, 35%, p = 0.003). Day 1 serum endotoxin concentrations were higher in patients with a severe outcome (median (interquartile range) 314 (173-563) pg/ml v 0 (0-185) pg/ml, p<0.01) and in non-survivors (266 (173-586) pg/ml v 0 (0-165) pg/ml, p<0.01). Serum tumour necrosis factor was detectable in 47 of 109 samples (43%) from 38 patients (median 35 pg/ml, range 5-943 pg/ml). Day 1 serum tumour necrosis factor correlated with a worse prognostic score and a severe outcome in all patients (n = 38, r = 0.36, p = 0.027; r = 0.33, p<0.05) and with mortality in patients with gall stones (n = 23, r = 0.50, p = 0.02). Our data suggest that endotoxin and tumour necrosis factor could be prognostic factors in severe acute pancreatitis.
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机译：内毒素血症和循环肿瘤坏死因子是严重脓毒症的重要预后因素，与败血性休克的发病机制有关。由于急性胰腺炎的临床和病理特征类似于败血性休克，因此本研究试图确定内毒素和肿瘤坏死因子是否是38例预后严重的急性胰腺炎患者的预后因素。内毒素血症在第1天出现在19/37（51％）患者中，在非幸存者中比幸存者更为常见（10 / 11，91％对9 / 26，35％，p = 0.003）。结果严重的患者（中位（四分位间距）314（173-563）pg / ml vs 0（0-185）pg / ml，p <0.01）和非存活者（266）第1天血清内毒素浓度更高（173-586）pg / ml v 0（0-165）pg / ml，p <0.01）。在38位患者的109个样本中有47个（43％）可检测到血清肿瘤坏死因子（中值35 pg / ml，范围5-943 pg / ml）。第1天血清肿瘤坏死因子与所有患者的预后差和严重预后相关（n = 38，r = 0.36，p = 0.027; r = 0.33，p <0.05）和胆结石患者的死亡率（n = 23，r = 0.50，p = 0.02）。我们的数据表明内毒素和肿瘤坏死因子可能是重症急性胰腺炎的预后因素。
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