Abstract
BackgroundRecent data shows that patients with severe acute pancreatic might benefit from early intensive therapy, enteral nutrition and timely transfer to specialized centers. The early prophylactic use of antibiotics in AP remains controversial. The role and need for new markers in stratification of acute pancreatitis is also uncertain. This study aims to evaluate the prognostic usefulness of adipokines in prediction of the severity and outcome of acute pancreatitis (AP).MethodsProspective study was conducted in four clinical centers. The diagnosis and severity assessment of AP was established according to the revised 2012 Atlanta classification. Adipokines, IL-6 and CRP levels were measured at admission and on 3rd day of hospital stay and compared with the control group. The predictive accuracy of each marker was measured by area under the receiver operating curve.ResultsForty healthy controls and 102 patients were enrolled in to the study. Twenty seven (26.5 %) patients had mild, 55 (53.9 %) - moderate and 20 (19.6 %) - severe AP. Only resistin (cut-off value 13.7 ng/ml) and IL-6 (cut-off value 473.4 pg/ml) were reliable early markers of SAP. IL-6 with cut-off value of 157.0 pg/ml was a predictor of necrosis. The peripancreatic necrosis volume of 112.5 ml was a marker of SAP and 433.0 ml cut-off value could be used to predict the need of interventions.ConclusionsThe prognostic value of adipokines in AP is limited. Only admission resistin levels could serve as an early predictor for SAP.The Lithuanian Regional Ethics Committee approved the study protocol (permission No. L-12-02/1/2/3/4) and all the patients and the control group provided written informed consent.
Highlights
Recent data shows that patients with severe acute pancreatic might benefit from early intensive therapy, enteral nutrition and timely transfer to specialized centers
This study has shown that both adipokines concentrations had significant differences between mild AP (MAP) and severe AP (SAP) groups, they correlate with severity of disease, need for interventions and outcome
The cut-off value of 13.7 ng/ml predicts SAP on admission. This is consistent with the results presented by Schaffler group which demonstrated that admission resistin cut-off value of >11.9 ng/mL can serve as a positive predictor of a Balthazar score >3 and Necrosis score >2 [21]
Summary
Recent data shows that patients with severe acute pancreatic might benefit from early intensive therapy, enteral nutrition and timely transfer to specialized centers. Non-complicated forms of AP can be treated in smaller regional hospitals, but the patients with the severe course of AP should be timely transferred to the high volume centers [5]. A number of predictive markers and scoring systems were introduced in to clinical practice for early prediction of severe AP (SAP), local or systemic complications and mortality. According to the newest Japanese guidelines for the management of acute pancreatitis based on recent meta-analysis, the prophylactic administration of antibiotics in SAP and necrotizing pancreatitis may improve the prognosis, if carried out within 72 h after onset of AP [5, 12, 13]. The discussion about the early use of antibiotics is still open, because it may turn out that they are useful for selective patient group
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