Abstract
BackgroundVarious serum markers for early identification of severe acute pancreatitis (SAP) have been studied. Serum macrophage migration inhibitory factor (MIF) was reported to be correlated with severity of acute pancreatitis (AP) based on the 1992 Atlanta classification. However, MIF has never been proven to be predictive of disease severity based on the revised Atlanta classification (RAC). The potential predictive value of MIF needs to be further validated.MethodsConsecutive patients with AP within 48 h after symptom onset and 10 healthy control volunteers were enrolled prospectively. Serum MIF levels were measured by enzyme-linked immunosorbent assay (ELISA). The predictive value of MIF, clinical scores and other serum markers were determined.ResultsAmong 143 patients with AP, there were 52 (36.4%), 65 (45.5%) and 26 (18.1%) with mild, moderate and severe disease based on the RAC respectively. Compared with healthy volunteers, serum levels of MIF were significantly higher in AP patients, especially those with SAP (P < 0.001). Multivariate regression analysis indicated that increased serum MIF (cut-off 2.30 ng/ml, OR = 3.16, P = 0.008), IL-6 (cut-off 46.8 pg/ml, OR = 1.21, P = 0.043), APACHE II score (cut-off 7.5, OR = 2.57, P = 0.011) and BISAP score (cut-off 1.5, OR = 1.01, P = 0.038) were independent risk factors for predicting SAP (P < 0.05). By using the area under the receiver operating characteristic (ROC) curve (AUC), MIF (AUC 0.950) demonstrated more excellent discriminative power for predicting SAP than APACHE II (AUC 0.899), BISAP (AUC 0.886), and IL-6 (AUC 0.826).ConclusionsSerum MIF is a valuable early marker for predicting the severity of AP based on the RAC.
Highlights
Various serum markers for early identification of severe acute pancreatitis (SAP) have been studied
Step-up surgical interventions were generally performed in cases of infected pancreatic necrosis (IPN) and, if possible, postponed at least 3 ~ 4 weeks since disease onset [27]
Prediction of SAP One hundred and forty-three patients with AP were divided into two groups according to the presence of persistent organ failure (OF), ie, non-SAP group and SAP group (n = 26), and 10 healthy volunteers were chosen as control group
Summary
Various serum markers for early identification of severe acute pancreatitis (SAP) have been studied. A host of predictors, including clinical and laboratory markers (e.g., C-reactive protein and interleukins 6, 8, and 10) [5,6,7,8,9] and various scoring systems [10, 11], such as Acute Physiology and Chronic Health Evaluation (APACHE) II, Bedside Index for Severity in Acute Pancreatitis (BISAP), Systemic Inflammatory Response Syndrome (SIRS), have been studied to be associated with prediction of severity of AP. These predictors are either inconvenient to use or of limited clinical value. There is an urgent clinical need to identify a reliable predictor of disease severity
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