This is in accordance with the study by Yasuda and colleagues, who reported that an find more information increase in the serum concentration of soluble TREM-1, in samples taken within the first 72 hours after the onset of AP, correlated with Ranson score and Acute Physiology and Chronic Health Evaluation (APACHE) II score, and that soluble TREM-1 concentration was higher in patients with early organ dysfunction [30], who have a higher risk of death.Decreased levels of HLA-DR on blood monocytes and monocyte hyporesponsiveness to PAMPs are suggested as possible causes of the increased predisposition to infection observed in critically ill patients. Satoh and colleagues measured HLA-DR levels on blood monocytes at admission and 7 and 14 days after the onset of AP and found that a persistent decrease in HLA-DR level was associated with the presence of sepsis in later stages of the disease [31].

Mentula and colleagues reported that patients with AP and secondary infections had lower HLA-DR levels on days 14 and 21 of evolution than did healthy volunteers [32]. We measured HLA-DR expression in patients with AP at earlier times and found lower HLA-DR levels in patients with severe AP than in healthy volunteers and patients with mild AP. We also found significantly lower HLA-DR levels in infected patients three days after admission. Our results suggest that the early measurement of HLA-DR level might be useful for identifying patients with AP who are likely to develop a severe form of the disease and who are at high risk of infection.Ho and colleagues found that HLA-DR expression on less than 52.

3% of monocytes on the 10th day after admission correlated with late mortality in patients with severe AP [33]. Our results show that HLA-DR expression at early times does not correlate with patient survival. Mentula and colleagues report that low HLA-DR levels at admission correlate with the development of organ dysfunction in patients with AP [34] but that HLA-DR levels do not differ between survivors and nonsurvivors [32]. Mentula and colleagues also report that organ failure in patients with severe AP could be predicted at admission by a combination of high IL-6 and IL-10 concentrations [32]. In this study, we found persistently high serum concentrations of IL-6 and IL-10 in patients with severe AP and in patients who developed infection, but not in patients with mild AP or uninfected patients.

Our results Carfilzomib show that patients with severe AP had low HLA-DR expression on monocytes and high serum IL-10 concentration since the beginning of their disease, which suggest that they presented CARS and could have increased susceptibility to infection. These also suggest that in severe AP, a disease whose early state is a proinflammatory response, an anti-inflammatory response (CARS) develops simultaneously and probably increases the susceptibility to infection.