Demonstration of pancreatic protease-antiprotease complexes in the peritoneal fluid of patients with acute pancreatitis.

During a 4 year period (1972 to 1975), 69 patients with acute severe pancreatitis, of whom 58 had hemorrhagic pancreatitis, were treated with peritoneal lavage at the intensive care ward of Malmö General Hospital. The mortality rates in these four years were 27%, 28%, 17%, and 14%, respectively. Peritoneal exudates were analyzed from 10 patients with hemorrhagic pancreatitis, four of whom died. About 65% of alpha 2-macroglobulin was in complexed form, as was 15% of alpha 1-antitrypsin. Immunochemical analyses of the alpha 1-antitrypsin revealed the presence of trypsin, chymotrypsin, and elastase complexed with alpha 1-antitrypsin. This means that the pancreatic proteases had been activated, as only active proteases are bound by plasma protease inhibitors.