Print this page Email this page
Users Online: 25975
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 5  |  Issue : 3  |  Page : 161-166

Prognostic indicators in acute pancreatitis: Comparison of interleukin 6 and some selected severity scoring systems in acute pancreatitis


1 Department of General Surgery, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India
2 Department of Pathology, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India
3 Department of General Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
4 Department of Biochemistry, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India

Date of Web Publication19-Oct-2015

Correspondence Address:
Arjun Agarwal
35/c 8, Ashok Kiran Hospital, Rampur Garden, Bareilly, UP
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-9596.167510

Rights and Permissions
  Abstract 

Background: It is important to predict the severity of acute pancreatitis as early as possible in order to optimize the therapy and to prevent organ dysfunction and local complications. Several scores of severity have been proposed. New biochemical markers are now available besides physiological and radiological markers. Our study was done to know the relation between interleukin 6 (IL-6) concentrations, Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores and computed tomography (CT) severity index in acute pancreatitis.
Patients and Methods: The study was done in Jawaharlal Nehru Medical College, Aligarh Muslim University from December 2011 to November 2013. Blood sample was taken between 24 and 48 h from the onset of symptoms and IL-6 was assessed using ELISA method and compared with physiological APACHE-II and CT Severity scores.
Results: Mean IL-6 levels were found to be higher in higher APACHE-II score categories and the difference was significant statistically (P < 0.001). The correlation (Spearman's rank coefficient) also indicated a strong bivariate correlation of APACHE-II scores with IL-6 levels (ρ > 0.7). However, the IL levels did not correlate with the modified CT severity index.
Conclusion: APACHE-II scores show a strong correlation with IL-6 levels within the limitation of having patients of only lower order of APACHE-II scores. Nonsignificant correlation with CT severity index was found. This should encourage us to use biochemical parameters to determine the severity of acute pancreatitis instead of CT standards.

Keywords: Acute pancreatitis, Acute Physiology, and Chronic Health Evaluation II score, computed tomography severity score, interleukin 6


How to cite this article:
Agarwal A, Garg C, Khan S, Khan MA, Islam N. Prognostic indicators in acute pancreatitis: Comparison of interleukin 6 and some selected severity scoring systems in acute pancreatitis. Arch Int Surg 2015;5:161-6

How to cite this URL:
Agarwal A, Garg C, Khan S, Khan MA, Islam N. Prognostic indicators in acute pancreatitis: Comparison of interleukin 6 and some selected severity scoring systems in acute pancreatitis. Arch Int Surg [serial online] 2015 [cited 2024 Mar 29];5:161-6. Available from: https://www.archintsurg.org/text.asp?2015/5/3/161/167510


  Introduction Top


The clinical course of acute pancreatitis varies significantly between individuals. In most patients, the condition is mild and self-limiting, but approximately 20% of patients suffer severe attacks associated with prolonged hospitalization, significant morbidity, and mortality ranging between 30% and 50%. [1]

Because it is important to predict the severity of the illness as early as possible in order to optimize the therapy and to prevent organ dysfunction and local complications, several scores of severity have been proposed. Criteria of severity such as Ranson et al., [2] Glasgow, [3] Acute Physiology and Chronic Health Evaluation II (APACHE-II), [4] Balthazar score [5] or computed tomography (CT) severity index scores have been used for a long time. These scores assess the multiple organ dysfunction induced by the disease and consequently, the greater the number of organs injured, the greater the score. [6]

New serum markers have recently emerged and their potential for providing additional information on the severity of the disease is currently being evaluated. However, to become useful, such markers must be assessed in a large consecutive series of patients, including a significant proportion of severe cases, and the timing of the assessment must be related to the onset of the disease. Moreover, the usefulness of the new marker must be compared with established ones; the results must be reproducible and the new marker must be easy to detect in clinical laboratories.

Interestingly, when seeking medical attention (usually 12-24 h after the onset of pain) most patients do not exhibit multiple organ dysfunction, which is likely to emerge by the 2 nd or 3 rd day and at admission, numerous mediators can be detected in serum. If the concentration of these biologic factors is correlated to the severity of the disease, and if they are detected before the occurrence of multiple organ dysfunction, it is then conceivable that the therapeutic antagonism of these mediators might prevent or attenuate the severity of the multiple organ dysfunction, and consequently the outcome of the disease. These new factors might be important for the rapid scoring of the disease severity in the acute-phase and some of them might be used as potential therapeutic targets. Early grading of disease will also help in triage and subsequent management in the ward or Intensive Care Unit.

Many inflammatory and anti-inflammatory markers like C-reactive protein (CRP), tumor necrosis factor (TNF)-alpha, interleukin 6 (IL-6), and IL-10 have been studied to correlate them with disease severity in acute pancreatitis. IL-6, which is released by macrophages in response to tissue injury, is a mediator responsible for the synthesis of the acute-phase proteins, including CRP. Its serum concentrations peak just 24 h after the onset of inflammation thus helping us to predict the disease severity early. [7] The objective of this study was to determine the relation between IL-6 concentrations and APACHE-II scores and CT severity index in acute pancreatitis.


  Patients and Methods Top


The study was conducted at Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh from 1 st December 2011 to 30 th November 2013. Blood samples were collected and IL-6 values were assessed using ELISA. Samples were taken between 24 and 48 h after the onset of symptoms corresponding with the rise in IL levels in body.

Inclusion criteria

All patients coming to our hospital between December 2011 and November 2013 and diagnosed with acute pancreatitis. At least two of the three criteria are to be fulfilled to diagnose acute pancreatitis:

  1. Clinical signs and symptoms suggestive of pancreatitis (epigastric pain, radiation to back)
  2. Serum amylase >3 times normal range
  3. Radiological imaging (contrast-enhanced CT whole abdomen)


Interleukin 6, monoclonal anti-IL-6 antibody, bovine serum albumin, p-nitrophenyl phosphate, anti-human IgG alkaline phosphate conjugate, Tween-20, sodium azide, were from Sigma Chemical Company, USA. Polystyrene microtiter flat bottom ELISA plates having 96 wells (7 mm diameter) were from NUNC, Denmark. Antibodies were detected and quantified by ELISA using polystyrene flat bottom microtiter plates as solid phase. [8],[9] The method described by Alam and Ali was followed for the assay. [8]

Acute Physiology and Chronic Health Evaluation II score was calculated in all the patients. 12 physiological parameters were summated as acute physiology score (APS). Sum of APS score and age score with chronic health evaluation score was summated as APACHE-II score. [4] CT severity score was calculated using modified Balthazar's scoring. [5]

The data were analyzed using Statistical Package for Social Sciences, Version 15.0 (SPSS Inc. 233 South Wacker Drive, 11 th Floor, Chicago, IL 60606-6412). Data were divided into tertiles for the purpose of evaluation. Analysis of variance, independent samples t-test, and Chi-square test were used for evaluation of data. Confidence level of the study was kept at 95%, hence a P < 0.05 indicated a statistically significant intergroup difference.


  Results Top


A total of 50 patients with acute pancreatitis were enrolled in the study and their IL-6 levels were assessed. [Table 1] shows the distribution of cases according to tertiles of IL-6 values. All the IL-6 values were arranged in an ascending order and then divided into three equal parts. As the distribution was not divisible perfectly by three, hence first tertile was made of 16 data points, and subsequent tertiles comprised of 17 data points each. Subsequent analysis has been done around these tertile values of IL-6.
Table 1: Tertile distribution of cases according to increasing IL-6 levels


Click here to view


Comparison of demographic profile and patients characteristics across different tertiles of IL-6 is shown in [Table 2]. [Table 3] shows a comparison of mean IL-6 levels for APS, APACHE-II, and CT severity score [Figure 1]. The proportion of patients with APACHE-II (>4) values was found to be increasing with increasing IL-6 tertiles (P < 0.001) [Figure 2]. However, difference in mean IL-6 levels between lower Balthazar score (2) and high Balthazar score (>2) was not significant (P = 0.287). On evaluating the correlation between IL-6 levels and Balthazar score too, the correlation was weak (ρ = 0.119) [Figure 3]. [Figure 4] shows the relationship between outcome and IL-6. Outcome could be assessed in 48 cases only as two cases could not be followed up (1 patient left against medical advice (LAMA), another absconded) [Table 4].
Figure 1: Comparison of mean interleukin 6 levels for acute physiology score, Acute Physiology and Chronic Health Evaluation II and computed tomography severity score

Click here to view
Table 2: Comparison of demographic profile and patients characteristics and across different tertiles of IL-6


Click here to view
Table 3: Comparison of mean IL-6 levels for APS, APACHE-II, and CT severity score


Click here to view
Table 4: Correlation of IL-6 levels with outcome in acute pancreatitis


Click here to view
Figure 2: Comparison of interleukin 6 and Acute Physiology and Chronic Health Evaluation II scores

Click here to view
Figure 3: Comparison of interleukin 6 and computed tomography severity scores

Click here to view
Figure 4: Comparison of interleukin 6 levels with outcome of disease

Click here to view


Mean IL-6 levels of patients who died were higher (95.90 ± 0.20) as compared to those who were discharged (60.35 ± 17.51) [Figure 4]. No statistical tools were employed owing to fewer numbers of cases in expiry group. The two cases that died had APACHE-II scores of 11 and 14 and APS score of 8 and 12 respectively.

Mean IL-6 levels were found to be higher in higher APACHE-II score categories and the difference was significant statistically too (P < 0.001). The correlation (Spearman's rank coefficient) also indicated a strong bivariate correlation of APACHE-II scores with IL-6 levels (ρ > 0.7).


  Discussion Top


There have been a number of scoring and classification systems proposed for assessment of acute pancreatitis that a clinician is often confused hence there is always a need for an objective criteria through which a clinician could assess the severity of the disease and assess its complications. [10] In the recent years, several researchers have proposed the use of inflammatory markers, such as CRP, IL, TNF, as an indicator of the severity of acute pancreatitis. [11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24]

In the present study, we determined the association between IL-6 levels and severity of acute pancreatitis. For this purpose, the severity of acute pancreatitis was assessed using GCS, APACHE-II, APS and Balthazar scoring systems. All these scoring systems have been used for assessment of severity of acute pancreatitis. [6],[25],[26],[27]

Serum IL-6 levels of the patients were measured and were found to be ranging from 30.17 to 98.32. Leser et al. have reported mean IL-6 levels ranging from 22.0 ± 9.8 U/ml to 61.0 ± 15.0 U/ml for mild and severe acute pancreatitis which continued to decrease with the passage of time in hospital. [13] In the present study, we made an assessment between 24 and 48 h after the onset of symptoms. In another study, Sathyanarayan et al. had reported day 3 mean IL-6 levels in patients with severe pancreatitis to be 146.29 ± 57.53 as compared to 91.42 ± 71.65 pg/ml in patients with mild pancreatitis. These values are higher compared to those obtained in the present study. However, they may be attributed to difference in time of measurement. Various authors have tried to evaluate the efficacy of IL-6 levels for prediction of severity of pancreatitis using measurements at different time intervals and have found their varying accuracy. [21] On evaluating, the association between IL-6 levels and different demographic and clinical variables such as gender, rectal temperature, arterial pressure, heart rate, respiratory rate, PO 2 level, sodium, potassium, creatinine, hematocrit, white blood cell levels, and duration of hospital stay. we did not find any significant difference except for pH for the three tertile values of IL-6.

In a study by Williams and Simms, the predictive value of different scoring systems for length of stay and death as the outcome showed much different cut-off values to be of significance. In their study, they predicted APACHE scores >30 and GCS <3 to be predictors of poor outcome. [28] However, in the present study, none of the patients had a score at these extreme levels. With respect to severity of acute pancreatitis in the present study, Digalakis et al. showed APACHE-II score of 8 or less formed the mild group. [29] Thus, in the present study, only 3 patients had severe grade of acute pancreatitis. In the study of Sathyanarayan et al. 72 h cut-off value of IL-6 for prediction of severe acute pancreatitis was proposed to be 122 pg/ml. [22] However, in the present study, none of the patients had IL-6 levels to this extent. Thus, indicating that IL-6 levels in the present study were within the mild category of acute pancreatitis. However, IL-6 levels of all the patients with APACHE-II scores of 9 or above, indicative of severe acute pancreatitis were above 80 as compared to only 2 patients with APACHE-II scores <9. Thus, showing that 24-48 h IL-6 levels >80 pg/ml were 100% sensitive and 95.5% specific in predicting the APACHE-II based severity of acute pancreatitis. Within these limitations, a strong correlation between APACHE-II scores and IL-6 levels was observed, thus indicating that IL-6 levels could be used as a predictor of severity of acute pancreatitis even in a highly disproportionate sampling situation. However, despite having a strong correlation with APACHE-II scores, the absence of an association of IL-6 levels with any of the clinical and demographic variables fails to explain the physiology of rise in IL-6 levels. IL-6, unlike APACHE-II is not a scoring system based on clinical features, rather it in itself is an indicator of inflammatory activity in the patient. More so, when APACHE-II scoring system has been under criticism for its practical utility in demonstration of severity of acute pancreatitis. [30]

As per the explained pathophysiology of the role of cytokines in pancreatic injury, cytokines are a group of low-molecular-weight proteins that are physiologically active in small concentrations and have a diverse range of pharmacologic activities. Some of them, such as IL-1, TNF, and platelet-activating factor are considered mediators of disease progression. Others, such as IL-2, IL-6, IL-8, IL-10, and other oxygen free radicals are considered mainly to be markers of disease severity. They trigger and amplify the progression of several post inflammatory cascades, thereby inducing distal organ dysfunction. However, the same can be explained on the basis of early proinflammatory nature of IL-6, thus indicating its prognostic significance. [13] However, if we consider it to be an early proinflammatory cytokine and assume that it cautions about deterioration of clinical condition at a later date, then its strong correlation with APACHE-II which is eventually based on the clinical status of the patient comes under question. This is a valid question and takes us back to the perplexing situation of dilemma of classifying acute pancreatitis. [31]

Despite having a good correlation with clinical scoring systems (APACHE-II and APS), in the present study we did not find a good correlation between Balthazar score and IL-6 levels (ρ = 0.119; P = 0.287). One of the reasons for this could be that we had a highly disproportionate sample. In the present study, out of 30 patients in whom Balthazar scoring could be done, a total of 16 had Balthazar score of 2 only while only 2 patients had Balthazar score >8 (described as indicator of severe acute pancreatitis) and both of them died. Balthazar had indicated about the deficiencies of APACHE-II scoring systems, which fail to depict the clinical picture of a patient clearly and proposed a CT based scoring criteria to classify the severity of acute pancreatitis. [32] In the present study, although IL-6 showed a strong correlation with commonly used clinical scoring systems yet owing to having a disproportionate sample, we were unable to validate the association in higher severity grades of acute pancreatitis and most of the results obtained by us are limited to assessment of severity of acute pancreatitis within mild grades only. Owing to this situation, in the present study we failed to derive a clinical correlation between different clinical and biochemical parameters vis-a-vis IL-6 levels and hence despite getting a strong correlation, the practical utility of our results is limited.

The present study had a limitation of having patients of only lower order of APACHE-II scores. As per defined APACHE-II categories, only 6 patients had APACHE-II score >8. Similarly, all the patients had APS score <29, thus showing that the severity level of patients was similar and there was limited scope for quantitative assessment across different severity grades. The results here should be interpreted as correlations with lower severity grades of APACHE-II and APS.

In view of the observations in the present study, it is recommended that a study on larger sample size with focus on correlation of IL-6 levels with the clinical picture rather than a scoring system under scrutiny should be carried out so that not only the severity of the disease could be assessed but also the areas where intervention would help to bring down this severity could be brought into notice.


  Conclusion Top


Hence, it is concluded that the physiological APACHE-II scores show a strong correlation with IL-6 levels within the limitation of having patients of only lower order of APACHE-II scores. The validation of correlation in a larger sample size with a wider range of APACHE-II scores is recommended. However, the more commonly used CT severity index correlated poorly with IL-6 levels. This study emphasizes the role of biochemical markers instead of standard radiological parameters in predicting the severity of acute pancreatitis.

 
  References Top

1.
Isenmann R, Beger HG. Natural history of acute pancreatitis and the role of infection. Baillieres Best Pract Res Clin Gastroenterol 1999;13:291-301.  Back to cited text no. 1
    
2.
Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet 1974;139:69-81.  Back to cited text no. 2
[PUBMED]    
3.
Graham et al. Assessment Coma and Impaired Consciousness Teasdale, The Lancet 1974;304: 81-4.  Back to cited text no. 3
    
4.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818-29.  Back to cited text no. 4
[PUBMED]    
5.
Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: Value of CT in establishing prognosis. Radiology 1990;174:331-6.  Back to cited text no. 5
    
6.
Petrov MS, Windsor JA. Classification of the severity of acute pancreatitis: How many categories make sense? Am J Gastroenterol 2010;105:74-6.  Back to cited text no. 6
    
7.
Pezzilli R, Billi P, Miniero R, Fiocchi M, Cappelletti O, Morselli-Labate AM, et al. Serum interleukin-6, interleukin-8, and beta 2-microglobulin in early assessment of severity of acute pancreatitis. Comparison with serum C-reactive protein. Dig Dis Sci 1995;40:2341-8.  Back to cited text no. 7
    
8.
Alam K, Ali R. Human autoantibody binding to multiple conformations of DNA. Biochem Int 1992;26:597-605.  Back to cited text no. 8
    
9.
Islam N, Ali R. Immunological studies on DNA lysine photoadduct. IUBMB Life 1998;45:453-64.  Back to cited text no. 9
    
10.
Yadav D. Acute pancreatitis: Too many classifications-what is a clinician or researcher to do? Clin Gastroenterol Hepatol 2014;12:317-9.  Back to cited text no. 10
    
11.
Papachristou GI, Clermont G, Sharma A, Yadav D, Whitcomb DC. Risk and markers of severe acute pancreatitis. Gastroenterol Clin North Am 2007;36:277-96, viii.  Back to cited text no. 11
    
12.
Digalakis MK, Katsoulis IE, Biliri K, Themeli-Digalaki K. Serum profiles of C-reactive protein, interleukin-8, and tumor necrosis factor-alpha in patients with acute pancreatitis. HPB Surg 2009;2009:878490.  Back to cited text no. 12
    
13.
Leser HG, Gross V, Scheibenbogen C, Heinisch A, Salm R, Lausen M, et al. Elevation of serum interleukin-6 concentration precedes acute-phase response and reflects severity in acute pancreatitis. Gastroenterology 1991;101: 782-5.  Back to cited text no. 13
    
14.
Viedma JA, Pérez-Mateo M, Domínguez JE, Carballo F. Role of interleukin-6 in acute pancreatitis. Comparison with C-reactive protein and phospholipase A. Gut 1992; 33:1264-7.  Back to cited text no. 14
    
15.
Heath DI, Cruickshank A, Gudgeon M, Jehanli A, Shenkin A, Imrie CW. Role of interleukin-6 in mediating the acute phase protein response and potential as an early means of severity assessment in acute pancreatitis. Gut 1993;34:41-5.  Back to cited text no. 15
    
16.
Inagaki T, Hoshino M, Hayakawa T, Ohara H, Yamada T, Yamada H, et al. Interleukin-6 is a useful marker for early prediction of the severity of acute pancreatitis. Pancreas 1997;14:1-8.  Back to cited text no. 16
    
17.
Berney T, Gasche Y, Robert J, Jenny A, Mensi N, Grau G, et al. Serum profiles of interleukin-6, interleukin-8, and interleukin-10 in patients with severe and mild acute pancreatitis. Pancreas 1999;18:371-7.  Back to cited text no. 17
    
18.
Pooran N, Indaram A, Singh P, Bank S. Cytokines (IL-6, IL-8, TNF): Early and reliable predictors of severe acute pancreatitis. J Clin Gastroenterol 2003;37:263-6.  Back to cited text no. 18
    
19.
Jiang CF, Shiau YC, Ng KW, Tan SW. Serum interleukin-6, tumor necrosis factor alpha and C-reactive protein in early prediction of severity of acute pancreatitis. J Chin Med Assoc 2004;67:442-6.  Back to cited text no. 19
    
20.
Ohmoto K, Yamamoto S. Serum interleukin-6 and interleukin-10 in patients with acute pancreatitis: Clinical implications. Hepatogastroenterology 2005;52:990-4.  Back to cited text no. 20
    
21.
Chao KC, Chao KF, Chuang CC, Liu SH. Blockade of interleukin 6 accelerates acinar cell apoptosis and attenuates experimental acute pancreatitis in vivo. Br J Surg 2006;93:332-8.  Back to cited text no. 21
    
22.
Sathyanarayan G, Garg PK, Prasad H, Tandon RK. Elevated level of interleukin-6 predicts organ failure and severe disease in patients with acute pancreatitis. J Gastroenterol Hepatol 2007;22:550-4.  Back to cited text no. 22
    
23.
Aoun E, Chen J, Reighard D, Gleeson FC, Whitcomb DC, Papachristou GI. Diagnostic accuracy of interleukin-6 and interleukin-8 in predicting severe acute pancreatitis: A meta-analysis. Pancreatology 2009;9:777-85.  Back to cited text no. 23
    
24.
Andersson E, Axelsson J, Eckerwall G, Ansari D, Andersson R. Tissue factor in predicted severe acute pancreatitis. World J Gastroenterol 2010;16:6128-34.  Back to cited text no. 24
    
25.
Johnson CD, Kingsnorth AN, Imrie CW, McMahon MJ, Neoptolemos JP, McKay C, et al. Double blind, randomised, placebo controlled study of a platelet activating factor antagonist, lexipafant, in the treatment and prevention of organ failure in predicted severe acute pancreatitis. Gut 2001;48:62-9.  Back to cited text no. 25
    
26.
Spanier BW, Nio Y, van der Hulst RW, Tuynman HA, Dijkgraaf MG, Bruno MJ. Practice and yield of early CT scan in acute pancreatitis: A Dutch Observational Multicenter Study. Pancreatology 2010;10:222-8.  Back to cited text no. 26
    
27.
Tenner S, Sica G, Hughes M, Noordhoek E, Feng S, Zinner M, et al. Relationship of necrosis to organ failure in severe acute pancreatitis. Gastroenterology 1997;113:899-903.  Back to cited text no. 27
    
28.
Williams M, Simms HH. Prognostic usefulness of scoring systems in critically ill patients with severe acute pancreatitis. Crit Care Med 1999;27:901-7.  Back to cited text no. 28
    
29.
De Sanctis JT, Lee MJ, Gazelle GS, Boland GW, Halpern EF, Saini S, et al. Prognostic indicators in acute pancreatitis: CT vs APACHE II. Clin Radiol 1997;52:842-8.  Back to cited text no. 29
    
30.
Varani J, Ginsburg I, Schuger L, Gibbs DF, Bromberg J, Johnson KJ, et al. Endothelial cell killing by neutrophils. Synergistic interaction of oxygen products and proteases. Am J Pathol 1989;135:435-8.  Back to cited text no. 30
    
31.
Dambrauskas Z, Giese N, Gulbinas A, Giese T, Berberat PO, Pundzius J, et al. Different profiles of cytokine expression during mild and severe acute pancreatitis. World J Gastroenterol 2010;16:1845-53.  Back to cited text no. 31
    
32.
Balthazar EJ. Acute pancreatitis: Assessment of severity with clinical and CT evaluation. Radiology 2002;223:603-13.  Back to cited text no. 32
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


This article has been cited by
1 Does the Automatic Measurement of Interleukin 6 Allow for Prediction of Complications during the First 48 h of Acute Pancreatitis?
Witold Kolber,Paulina Dumnicka,Malgorzata Maraj,Beata Kusnierz-Cabala,Piotr Ceranowicz,Michal Pedziwiatr,Barbara Maziarz,Malgorzata Mazur-Laskowska,Marek Kuzniewski,Mateusz Sporek,Jerzy Walocha
International Journal of Molecular Sciences. 2018; 19(6): 1820
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Patients and Methods
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed4686    
    Printed249    
    Emailed0    
    PDF Downloaded299    
    Comments [Add]    
    Cited by others 1    

Recommend this journal