Endotoxin and anti-endotoxin antibodies in the prognosis of acute pancreatitis.

AIMS: We investigate the behaviour of endotoxin in patients with acute pancreatitis and its relationship with the development of complications.

EXPERIMENTAL DESIGN: Prospective study.

PATIENTS: We assessed plasmatic endotoxin and anti-core endotoxin antibodies (EndoCab IgG and IgM) levels on first and third days from admission in patients with acute pancreatitis episodes, classifying them as mild or severe according to Atlanta's criteria.

RESULTS: Nineteen patients were included, seven with severe pancretitis (36.8%) and twelve with mild pancreatitis (63.2%). Endotoxin levels were similar on first day in both mild and severe pancreatitis, and higher in the latter on third day (p > 0.05). Patients with severe pancretitis had lower EndoCab IgM levels on first and third days from admission (day 1: 18.3 vs 33.3 MU/ml, p < 0.01; day 3: 18.4 vs 33.4 MU/ml, p < 0.05). When analysed separately systemic and local complications, we observed, in the same days, a decrease of EndoCab IgM levels in patients who developed systemic complications (day 1: 18.3 vs 32.7 MU/ml, p = 0.01; day 3: 18.3 vs 35.1 MU/ml, p < 0.01). EndoCab IgG levels were also lower in severe acute pancreatitis in both determinations, but differences weren't significant.

CONCLUSIONS: EndoCab levels decrease early in severe acute pancreatitis, mainly if systemic complications are present. This antibody depletion is greater for IgM than IgG, and seems to occur earlier than an increase in endotoxemia.