Serum apolipoprotein B-to-apolipoprotein A1 ratio is independently associated with disease severity in patients with acute pancreatitis

Jiayuan Wu,Xiaoming Chen,Wenkai Tan,Shicai Ye,Yufeng Wang,Hongyan Li

doi:10.1038/s41598-019-44244-w

Jiayuan Wu, Xiaoming Chen + Show 4 more

Open Access

https://doi.org/10.1038/s41598-019-44244-w

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Journal: Scientific Reports	Publication Date: May 23, 2019
Citations: 19	License type: open-access

Affiliation: Guangdong Medical College

Abstract

Early identification of severe acute pancreatitis (SAP) is critical for clinical decision-making. The apolipoprotein B-to-apolipoprotein A1 ratio (ApoB/A1 ratio) reflects the balance between pro-inflammation and anti-inflammation in vivo. This study investigated the association between serum ApoB/A1 ratio at admission and acute pancreatitis (AP) severity. A total of 375 patients with first attack of AP were retrospectively recruited from January 2014 to December 2017. The severity of AP was assessed at admission based on the 2012 revised Atlanta Classification. Serum lipids levels were tested on the first 24 h of hospitalization, of which the correlations with clinical features or scoring systems were also measured. The ApoB/A1 ratio markedly increased across disease severity of AP. The ApoB/A1 ratio, expressed as both quartile and continuous variables, was significantly associated with a high risk of SAP, even after adjustment for other conventional SAP risk factors. The ApoB/A1 ratio positively correlated with the revised 2012 Atlanta Classification, Ranson score, Bedside Index for Severity in AP score, Modified Computed Tomography Severity Index score, and Acute Physiology and Chronic Health Evaluation II score for AP severity. The optimal cut-off value of ApoB/A1 ratio for detecting SAP was 0.88, with a sensitivity of 83.08% and a specificity of 69.03%. Serum ApoB/A1 ratio at admission is closely correlated with disease severity in patients with AP and can serve as a reliable indicator for SAP in clinical setting.

Highlights

Acute pancreatitis (AP) is a common and serious digestive disease that represents a sudden inflammation of the pancreatic gland
Given that the inflammatory process in acute pancreatitis (AP) differs from the disease severity, an important aspect of managing AP is the classification of disease severity at an early stage
Considering the significant effect of systemic inflammatory response on the pathophysiological progress of AP, we hypothesized that apolipoprotein B (ApoB)/A1 ratio could serve as a reliable inflammatory predictor of AP severity

Summary

Introduction

Acute pancreatitis (AP) is a common and serious digestive disease that represents a sudden inflammation of the pancreatic gland. The physiological functions of ApoA1 in vivo include preventing the interaction between T lymphocytes and macrophages as well as inhibiting the production of various inflammatory factors, thereby restricting the “waterfall” effect of inflammation and playing an antioxidant role[12]. ApoB-to-ApoA1 ratio (ApoB/A1 ratio) is a composite index that comprehensively reflects the lipid metabolism balance and inflammatory status in the human body. Considering the significant effect of systemic inflammatory response on the pathophysiological progress of AP, we hypothesized that ApoB/A1 ratio could serve as a reliable inflammatory predictor of AP severity. We conducted this observational study to investigate the correlation between AP severity and ApoB/A1 ratio at admission

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Conclusion