IL-6 and CRP are superior in early severity stratification of acute pancreatitis

Abstract

Background: The revised Atlanta classification (RAC) on acute pancreatitis (AP) presents distinct criteria for severity categorization.[1] Currently all patients with AP are hospitalized and managed identically. As incidence, and subsequently financial costs, is rising the necessity of early differentiation in AP will increase. This study aimed to investigate the capacity of biomarkers to stratify AP patients early in the course of the disease. Methods: Patients with AP were consecutively enrolled and dichotomized into mild versus moderately severe plus severe AP (non-mild) according to the RAC. Serum samples taken within 13-36 hours after onset of disease were analyzed for 20 biomarkers. Through receiver operating curves cut-offs were set for the biomarkers that differed significantly between the mild and non-mild group. Patients were additionally classified according to the harmless acute pancreatitis score (HAPS).[2] Results: Among the 175 patients, 70.9 % had mild and 29.1 % non-mild AP. CRP and IL-6 combined, with the cut-off levels 57.0 and 23.6 respectively, demonstrated superior discriminative capacity with an area under the curve of 0.803, sensitivity 98%, specificity 54% and a positive and negative likelihood ratio of 2.1 and 0.06 for the non-mild group. Regarding the mild cases, the identification potential of the HAPS was generally inferior compared to CRP plus IL-6. Conclusion: In this study CRP and IL-6 demonstrate a clinically relevant capacity to differentiate mild from non-mild AP early in the course of AP.