Evaluation of Immunological Parameters in the Determination of Acute Biliary Pancreatitis Mortality and Morbidity

Scoring systems, imaging methods or blood markers used to determine the prognosis of pancreatitis but they are not sufficient alone. In our study, it is aimed to reveal the importance of immunophenotyping and serum cytokines in predicting the severity of acute biliary pancreatitis. Our study were performed between July 2019 and June 2020. Patients were divided into three groups as mild, moderate and severe acute biliary pancreatitis based on the modified Atlanta criteria. Immunephenotyping including helper T cells, cytotoxic T cells, natural killer cells, monocytes and immune checkpoints, and IL-1β, IFN-α2, IFN-γ, TNF-α, MCP-1, IL-6, IL-8, IL-10, IL-12p (p70), IL-17A, IL-18, IL-23 and IL-33 cytokine measurements were performed and compared between groups. A total of 65 patients including 24 mild, 22 moderate, 19 severe pancreatitis, and 20 healthy volunteers were included to the study. In immunophenotyping with a flow cytometry, the ratios of natural killer cells, classical monocytes, CD3+, CD4+ lymphocytes, monocytes, HLA-DR on CD14+ cells decreased and PDL-1 positivity on CD14+ cells, PD-1 positivity on CD4+ and CD8+ lymphocytes, and intermediate monocyte ratios increased with the severity of pancreatitis. Also IL-6, IL-8 and IL-33 increased with the severity of pancreatitis, IL-10 and IL-18 increased in pancreatitis, but reached the highest level in moderate pancreatitis and started to decrease in severe pancreatitis. In conclusion, our study showed that both lymphocyte count, HLA-DR, PD-1, PD-L1, natural killer cells and monocyte subtyping as well as IL-6, IL-8, IL-10, IL-18, IL-33 cytokines could be useful to predict the severity of pancreatitis.