Prediction of acute pancreatitis severity via the combined analysis of inflammatory biomarkers and coagulation parameters

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Introduction. Timely assessment of severity of acute pancreatitis is needed to avoid severe systemic complications by making optimal therapeutic approach and correct prognosis of the disease. The aim of the study was to establish the role of several inflammatory biomarkers and coagulation parameters in prediction of AP severity, and also to propose a mathematical formula which allows their combined use for the same purpose. Material and Methods. The prospective study included 70 patients with AP. The patients were divided into groups: mild (group I), moderate (group II) and severe AP (group III). All patients were further classified into two groups: group A (mild AP) and group B (moderate and severe AP). Biochemical markers, inflammatory biomarkers and coagulation factors were tested in all patients. Results. Based on the results of Mann-Whitney,s test, it can be concluded that groups A and B are significant different from each other for CRP (p<0.05). Using the Wald’s stepwise forward method, a prediction model with CRP, PCT, D-dimer1, D-dimer3, fibrinogen1 and fibrinogen3 parameters as predictors of the severity of AP was obtained. The percentage of successful prediction of moderate or severe AP based on this model was 76.9%. The use of ROC analysis with the introduced linear combination from the logistic regression yielded equally good or even better results in the assessment of the severity of AP with the combined use of analyzed parameters. Conclusion. The combined analyses of biohumoral markers and coagulation parameters presented in the form a mathematical formula enabled a more accurate, rapid, rational and clinically available prediction of the severity of AP.

1. Do JH. Mechanism of Severe Acute Pancreatitis: focusing on development and progression. The Korean Journal of Pancreas and Biliary Tract 2015 Jul;20(3):115-23. DOI: 10.15279/kpba.2015.20.3.115

2. Fiusa MML, Carvalho-Filho A, Annichino-Bizzacchi JM, De Paula EV: Causes and consequences of coagulation activation in sepsis: an evolutionary medicine perspective. BMC Med 2015 May; 13: 105. DOI: 10.1186/s12916-015-0327-2

3. Lisman T, Porte RJ. Activation and regulation of hemostasis in acute liver failure and acute pancreatitis. Semin Thromb Hemost. 2010;36:437-43. DOI: 10.1055/s-0030-1254052

4. Yang CJ, Chen J, Phillips ARJ, Windsor JA, Petrov MS. Predictors of severe and critical acute pancre atitis: A systematic review. Dig Liver Dis 2014 May; 46(5):446-51. DOI: 10.1016/j.dld.2014.01.158

5. Thandassery RB, Yadav TD, Dutta U, Appasani S, Singh K, Kochhar R. Prospective validation of a 4-category classification of acute pancreatitis severity. Pancreas 2013 Apr;42(3):392-6. DOI: 10.1097/MPA.0b013e3182730d19

6. Granger J, Remick D. Acute pancreatitis: models, markers, and mediators. Shock 2005 Dec; 24(Suppl 1):45-51. DOI: 10.1097/01.shk.0000191413.94461.b0

7. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis 2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62:102-11. DOI: 10.1136/gutjnl-2012-302779

8. Meher S, Mishra TS, Sasmal PK, Rath S, Sharma R, Rout B, Sahu MK. Role of Biomarkers in Diagnosis and Prognostic Evaluation of Acute Pancreatitis. J Biomark 2015; Article ID 519534, 13 pages.

9. Khanna AK, Meher S, Prakash S, Tiwary SK, Singh U, Srivastava A, et al. Comparison of Ranson, Glasgow, MOSS, SIRS, BISAP, APACHE-II, CTSI Scores, IL-6, CRP, and procalcitonin in predicting severity, organ failure, pancreatic necrosis, and mortality in acute pancreatitis. HPB Surgery 2013; Article ID 367581, 10 pages.

10. Matull WR, Pereira SP, O’Donohue JW. Biochemical markers of acute pancreatitis J Clin Pathology 2006; 59(4):340-4. DOI: 10.1136/jcp.2002.002923

11. Bettina R, Schilling MK, Beger HG. Laboratory markers of severe acute pancreatitis. Dig Dis 2004;22:247-57.

12. Bradley 3rd EL. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg 1993;128:586-90. DOI: 10.1001/archsurg.1993.01420170122019

13. Badhal SS, Sharma S, Saraya A, Mukhopadhyay AK. Prognostic significance of D-dimer, natural anticoagulants and routine coagulation parameters in acute pancreatitis. Trop Gastroenterol 2012 Jul-Sep; 33(3):193-9. DOI: 10.7869/tg.2012.48

14. Melzi D’Eril, GV, Merlini G, Finazzi S, Bosoni T, Barakat B, Pezzilli R. Procalcitonin is not a reliable marker for the assessment of severity in acute pancreatitis without infectious complications. Clin Chem 2000 Mar; 46(3):428-30.

15. Muller CA, Uhl W, Printzen G, Gloor B, Bischofberger H, Tcholakov O, Buchler MW. Role of procalcitonin and granulocyte colony stimulating factor in the early prediction of infected necrosis in severe acute pancreatitis. Gut 2000; 46(2):233-8. DOI: 10.1136/gut.46.2.233

16. Frasquet J, Saez J, Trigo C, Martínez J, Such J, Pérez-Mateo M, et al. Early measurement of procalcitonin does not predict severity in patients with acute pancreatitis. Br J Surg 2003 Sep; 90(9):1129-30. DOI: 10.1002/bjs.4172

17. Modrau IS, Floyd AK, Thorlacius-Ussing O. The clinical value of procalcitonin in early assessment of acute pancreatitis. Am J Gastroenterol 2005 Jul; 100(7):1593-7. DOI: 10.1111/j.1572-0241.2005.41456.x

18. Rau BM, Kemppainen EA, Gumbs AA, Büchler MW, Wegscheider K, Bassi C, et al. Early Assessment of Pancreatic Infections and Overall Prognosis in Severe Acute Pancreatitis by Procalcitonin: A Prospective International Multicenter Study. Ann Surg 2007 May; 245(5):745-54. DOI: 10.1097/01.sla.0000252443.22360.46

19. Pezzilli R, D’Eril GVM, Morselli-Labate AM, Merlini G, Barakat B, Bosoni T et al. Serum amyloid A, procalcitonin, and C-reactive protein in early assessment of severity of acute pancreatitis. Dig Dis Sci 2000 Jun; 45(6):1072-8. DOI: 10.1023/A:1005525329939

20. Tenner S, Baillie J, DeWitt J, Swaroop Vege S. American college of gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol 2013 Sep; 108(9):1400-15. DOI: 10.1038/ajg.2013.218

21. Cardoso FS, Ricardo LB, Oliveira AM, Horta DV, Papoila AL, Deus JR et al. C-reactive Protein at 24 Hours after Hospital Admission May Have Relevant Prognostic Accuracy in Acute Pancreatitis: A Retrospective Cohort Study. GE Port J Gastroenterol. 2015; 22(5):198-203. DOI: 10.1016/j.jpge.2015.03.002

22. Gould T, Mai S, Liaw PC. Coagulation Abnormalities in Acute Pancreatitis, In: Rodrigo L, Editor. Pancreatitis - Treatment and Complications. InTech: 2012. p. 59-72. DOI: 10.5772/30169

23. Salomone T, Tosi P, Palareti G, Tomassetti P, Migliori M, Guariento A, et al. Coagulative disorders in human acute pancreatitis: role for the D-dimer. Pancreas 2003 Mar; 26(2):111-6. DOI: 10.1097/00006676-200303000-00003

24. Radenkovic D, Bajec D, Ivancevic N, Milic N, Bumbasirevic V, Jeremic V, et al. D-dimer in acute pancreatitis: a new approach for an early assessment of organ failure. Pancreas 2009 Aug; 38(6):655-60. DOI: 10.1097/MPA.0b013e3181a66860

25. Boskovic A, Pasic S, Soldatovic I, Milinic N, Stankovic I. The role of D-dimer in prediction of the course and outcome in pediatric acute pancreatitis. Pancreatology 2014 Sep-Oct; 14(5):330-4. DOI: 10.1016/j. pan.2014.07.015

Revista Romana de Medicina de Laborator

Romanian Journal of Laboratory Medicine

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