Abstract
Severe acute pancreatitis (SAP) concerns 10–20% of acute pancreatitis (AP) patients and is associated with a poor prognosis and high mortality. An early prognosis of the unfavorable outcome, transfer to an intensive care unit (ICU) and the introduction of an adequate treatment are crucial for patients’ survival. Recently, the elevated circulating urokinase-type plasminogen activator receptor (uPAR) has been reported to predict SAP with a high diagnostic accuracy among patients in a tertiary center. The aim of the study was to compare the diagnostic utility of uPAR and other inflammatory markers as the predictors of the unfavorable course of AP in patients admitted to a secondary care hospital within the first 24 h of the onset of AP. The study included 95 patients, eight with a SAP diagnosis. Serum uPAR was measured on admission and in the two subsequent days. On admission, uPAR significantly predicted organ failure, acute cardiovascular failure, acute kidney injury, the need for intensive care, and death. The diagnostic accuracy of the admission uPAR for the prediction of SAP, organ failure, and ICU transfer or death was low to moderate and did not differ significantly from the diagnostic accuracy of interleukin-6, C-reactive protein, procalcitonin, D-dimer and soluble fms-like tyrosine kinase-1. In the secondary care hospital, where most patients with AP are initially admitted, uPAR measurements did not prove better than the currently used markers.
Highlights
Acute pancreatitis (AP) is one of the most common acute digestive tract diseases and, despite significant medical advancement in the last decade, it still poses a risk of life-threatening complications
Average Ranson’s score was higher among patients with moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP), while systemic inflammatory response syndrome (SIRS) was common among both MSAP and SAP patients
The early identification of patients who are at risk of AP complicated by organ failure enables the provision of better care and allows for the proper allocation of intensive care resources
Summary
Acute pancreatitis (AP) is one of the most common acute digestive tract diseases and, despite significant medical advancement in the last decade, it still poses a risk of life-threatening complications. Recent studies indicate that in consequence of the systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) nearly half of deaths occur within the first week of AP [1,4,5] These findings have been reflected in the 2012 revised Atlanta classification [6], which defines the early and the late phases of the disease. The first 48 h are important for the further course of AP as adequate clinical management (including intensive fluid resuscitation) during the so-called therapeutic window can reduce the risk of complications [1,3,4,7] This is especially important for patients developing MODS who should be referred to an intensive care unit (ICU) [7].
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