Red cell distribution width and neutrophil to lymphocyte ratio as predictors of outcomes in acute pancreatitis: A retrospective cohort study.

BACKGROUND: Acute pancreatitis is a commonly encountered emergency but accurately predicting that subset of patients who will become systemically unwell has proven difficult. Simple haematological prognostic markers, such as red cell distribution width (RDW) and neutrophil to lymphocyte ratio (NLR), could identify such patients. The aim of this study was to assess the usefulness of RDW and NLR measured on admission as predictors of mortality and intensive care (ICU) or high dependency unit (HDU) admission in patients with acute pancreatitis. MATERIALS AND METHODS: All patient who presented to our institution with acute pancreatitis between August 2013 and August 2016 were retrospectively identified using the prospectively maintained Hospital In-Patient Enquiry (HIPE) discharge audit. Data on survival, admission to HDU or ICU, length of stay and haematological parameters including RDW and NLR on presentation to the emergency department were collected. RESULTS: A total of 185 patients with acute pancreatitis were included of which 23 (12%) patients had a RDW above the upper limit of normal (ULN), which was associated with a significantly increased likelihood of admission to ICU or HDU (RR3.5; p = 0.01); 117 (63%) patients had a NLR above 5 on presentation, which also increased the risk of ICU or HDU admission (RR 8.1; p = 0.01). Patients who had both a RDW above the ULN and a raised NLR had an increased risk of inpatient mortality (RR 9.9; p = 0.04). CONCLUSION: RDW and NLR can identify patients at increased risk of severe acute pancreatitis on presentation to the Emergency Department.

Critical involvement of stress-activated mitogen-activated protein kinases in the regulation of intracellular adhesion molecule-1 in serosal fibroblasts isolated from patients with Crohn's disease.

BACKGROUND: Stricture formation in Crohn's disease occurs as a result of persistent fibroblast activation. Chronic inflammation seen in patients with Crohn's disease leads to enhanced adhesion molecule expression in fibroblasts. Stress-activated mitogen-activated protein kinases are critical signaling pathways that control expression of intracellular adhesion molecule-1 (ICAM-1) in inflammation. The purpose of this study was to investigate the involvement of stress-activated mitogen-activated protein kinases in the regulation of ICAM-1 expression by tumor necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta) in serosal fibroblasts isolated from patients with Crohn's disease. STUDY DESIGN: Fibroblasts were isolated from serosal biopsies of strictures in patients with Crohn's disease and normal colon in patients with colorectal carcinoma. Cell surface and whole cell ICAM-1 expression were evaluated by flow cytometry and Western blot analysis, respectively. Cells were stimulated with TNF-alpha and IL-1beta. To determine the mitogen-activated protein kinase signaling pathway required for ICAM-1 induction, cells were pretreated with inhibitors to Jun N-terminal kinase, p38 kinase, and p42/44 kinase. RESULTS: Baseline ICAM-1 expression was higher (p < 0.001) in fibroblasts isolated from strictures in patients with Crohn's disease (3.2 +/- 0.3) as compared with nonstrictured Crohn's fibroblasts (2.1 +/- 0.3) and control fibroblasts (1.6 +/- 0.1). TNF-alpha and IL-1beta increased ICAM-1 expression in both control and Crohn's disease. Pretreatment of fibroblasts with the Jun N-terminal kinase inhibitor dimethylaminopurine abolished TNF-alpha- and IL-1beta-stimulated ICAM-1 expression. CONCLUSIONS: Serosal fibroblasts isolated from strictures of patients with Crohn's disease demonstrate enhanced expression of ICAM-1. TNF-alpha and IL-1beta upregulate ICAM-1 expression in serosal fibroblasts through a Jun N-terminal kinase signaling pathway. Specific inhibition of inflammatory signaling pathways could provide novel therapeutic targets for treatment of Crohn's disease.