Soluble B7-H5 Is a Novel Diagnostic, Severity, and Prognosis Marker in Acute Pancreatitis

As an important ligand in T lymphocyte costimulatory pathways, B7-H5 is involved deeply in the immune response in various diseases. However, its clinical usefulness as an early indicator in acute pancreatitis (AP) remains unclear. In this study, the levels of sB7-H5 and cytokines in plasma samples of 75 AP patients, 20 abdominal pain patients without AP, and 20 healthy volunteers were determined. Then, the correlation of sB7-H5 and clinical features, cytokines, the Ranson score, APACHE II score, Marshall score, and BISAP score was analysed, and the value of sB7-H5 for diagnostic, severity, and prognosis of AP was evaluated. We found that the levels of sB7-H5 were specifically upregulated in AP patients. Receiver operating characteristic (ROC) analysis revealed that sB7-H5 can identify AP patients from healthy or abdominal pain patients with 78.9% or 86.4% sensitivity and 93.3% or 90.0% specificity. Further analysis showed that the levels of sB7-H5 were significantly correlated with WBC ( p = 0.004 ), GLU ( p = 0.008 ), LDH ( p < 0.001 ), Ca2+ ( p = 0.006 ), AST ( p = 0.009 ), PLT ( p = 0.041 ), IL-6 ( p < 0.001 ), IL-10 ( p < 0.001 ), and TNF-α ( p < 0.001 ). And levels of sB7-H5 were gradually increased among patients with mildly acute pancreatitis (MAP), moderately severe acute pancreatitis (MSAP), and severe acute pancreatitis (SAP). It can distinguish the severity of AP with good sensitivity and specificity. Moreover, when dividing the patients into two groups according to the median level of sB7-H5, the local complication and length of stay of low levels of the sB7-H5 group were significantly less than those in high levels of the sB7-H5 group. And the levels of sB7-H5 in AP patients were significantly correlated with the Ranson score ( p < 0.001 ), APACHE II score ( p < 0.001 ), Marshall score ( p < 0.001 ), and BISAP score ( p < 0.001 ). The AUCs of assessing local complications of sB7-H5 at day 1 and day 3 were 0.704 ( p = 0.0024 ) and 0.727 ( p = 0.0373 ). These results showed the potential value of sB7-H5 as a diagnostic, severity, and prognosis marker of AP.

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Clinical Proﬁle and Outcome of Patients with Severe Acute Pancreatitis

Asian Journal of Medical Research ◽

10.47009/ajmr.2020.9.3.me2 ◽

2020 ◽

Vol 9 (3) ◽

pp. 8-11

Author(s):

Rishabh Sehgal ◽

Inder Pal Singh ◽

Jyotisterna Mittal

Keyword(s):

Acute Pancreatitis ◽

Alcohol Consumption ◽

Severe Acute Pancreatitis ◽

Sofa Score ◽

Clinical Profile ◽

Etiological Factor ◽

Clinical Severity ◽

Apache Ii ◽

Apache Ii Score ◽

Marshall Score

Background: Acute pancreatitis (AP) is an acute inflammatory condition of the pancreas leading to pancreatic autodigestion. The present study was conducted to study the clinical profile and outcome of patients with severe acute pancreatitis. Subjects & Methods: The study was conducted on 40 patients of acute pancreatitis. Clinical profile including history, examination findings, etiology of pancreatitis, clinical severity (according to Modified Marshall Score, BISAP score, APACHE II, HAPS score, SOFA score) was recorded. Results: Severe Acute Pancreatitis (SAP) among patients. Majority of the patients i.e. 22 (55%) had alcohol consumption as etiological factor causing SAP followed by biliary 10 (25%) & idiopathic 5 (12.5%). Hypertriglyceridemia and drug-induced (herbal medication) pancreatitis was present in 1 (2.5%) patient each. Out of all 1 (2.5%), patients had a history of both alcohol consumption and the presence of gallstone as an etiological factor. 22 patients (55%) out of 40 patients only conservative management was used while 18(45%) patients underwent USG guided percutaneous drainage was done. Out of these 18 patients, 3(7.5%) patients required Laparoscopic Necrosectomy & 2(5%) patients required open necrosectomy in addition to ultrasound-guided PCD. Patients who improved had a mean BISAP SCORE of 2.15 0.54, Modified Marshall score of 3.65 1.44, APACHE II score of 9.77 4.45, SOFA score 5.54 2.49, RANSON’s score 3.85 1.80 and HAP score of 0.65 0.63. Conclusion: Most common etiology of severe acute pancreatitis is alcohol followed by biliary etiology. Out of severity scores (BISAP, APACHE-II, SOFA, HAPS), only BISAP score ≥3 is predictive of poor outcome in patients with severe acute pancreatitis.

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Combination of APACHE-II score and an obesity score (APACHE-O) for the prediction of severe acute pancreatitis

Pancreatology ◽

10.1159/000077021 ◽

2004 ◽

Vol 4 (1) ◽

pp. 1-6 ◽

Cited By ~ 88

Author(s):

C.D. Johnson ◽

S.K.C. Toh ◽

M.J. Campbell

Keyword(s):

Acute Pancreatitis ◽

Severe Acute Pancreatitis ◽

Apache Ii ◽

Apache Ii Score ◽

Score Apache

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Plasma ADAMTS13 activity parallels the APACHE II score, reflecting an early prognostic indicator for patients with severe acute pancreatitis

Scandinavian Journal of Gastroenterology ◽

10.1080/00365520802179933 ◽

2008 ◽

Vol 43 (11) ◽

pp. 1387-1396 ◽

Cited By ~ 18

Author(s):

Chie Morioka ◽

Masahito Uemura ◽

Tomomi Matsuyama ◽

Masanori Matsumoto ◽

Seiji Kato ◽

...

Keyword(s):

Acute Pancreatitis ◽

Severe Acute Pancreatitis ◽

Prognostic Indicator ◽

Apache Ii ◽

Apache Ii Score ◽

Adamts13 Activity

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Prognostic Indicator in Severe Acute Pancreatitis

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol03-i05/10 ◽

2018 ◽

Vol 3 (05) ◽

Author(s):

Dr. Ajay Khanolkar ◽

Dr. Manish Khare

Keyword(s):

Acute Pancreatitis ◽

Severe Acute Pancreatitis ◽

Surgical Intervention ◽

Financial Burden ◽

Fluid Collection ◽

Prognostic Indicator ◽

Apache Ii ◽

Management Decision ◽

Apache Ii Score ◽

Local Complication

Aim of study: - To assess the utility of each as prognostic indicator in Severe Acute Pancreatitis. Material and Methods: This prospective study entitled “To assess the utility of each as prognostic indicator in Severe Acute Pancreatitis” was carried out on patients hospitalized for acute pancreatitis in the surgery department at Chandulal Chandrakar Memorial Medical College and CM Hospital, Bhilai from March 2015 to October 2017.50 patients with the diagnosis of first attack of acute pancreatitis of both sexes and all age groups were selected for the study. Conclusion:- On the basis of observation and result of the study, it can be safely stated that APACHE II Scoring is quick, safe, reproducible, ongoing and cost effective. It can be done by resident or intelligent nursing staff. Give an idea regarding improving or worsening of patients. APACHE II Scoring system when complimented by high quality CECT abdomen can further refine the results and give an idea of likelihood of patients developing local complication. Thus it can also be used along with CECT abdomen for Risk Stratification of subset of patients who are likely to develop local complication who might need surgical intervention. CECT on 3rd day adds nothing to management. It has a tendency to over predict the regional complication, which are in anyway apart of natural course of history of disease (acute fluid collection). Management decision could not be based on CECT abdomen on 3rd day alone, since it is not needed to make a diagnosis of acute pancreatitis it should be abundant, thus reducing the financial burden of patients and institute. CECT abdomen done after 2nd week in the course of illness along with APACHE II Score and clinical finding are better guide for management and surgical intervention.

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Intra-Abdominal Pressure, a Prognostic Marker in the Evolution of Acute Pancreatitis

Acta Medica Transilvanica ◽

10.2478/amtsb-2019-0016 ◽

2019 ◽

Vol 24 (4) ◽

pp. 51-55

Author(s):

Alina Simona Bereanu ◽

Bogdan Vintilă ◽

Mihai Sava

Keyword(s):

Acute Pancreatitis ◽

Prognostic Marker ◽

Clinical Laboratory ◽

Apache Ii ◽

Prognostic Scores ◽

Apache Ii Score ◽

Abdominal Pressure ◽

Operating Characteristics ◽

Specificity And Sensitivity ◽

Ranson Score

Abstract In acute pancreatitis some prognostic scores have been suggested, based on clinical, laboratory and radiological criteria. The most popular are: Ranson score, APACHE II score and CT severity index (CTSI). The trend is to find a prognostic marker that is easy to use, cheap, and reproductible. Recently, the increase of the intra-abdominal pressure (IAP) has drawn attention. Material and Methods: From January 2012 to April 2014, a group of 64 patients, admitted to the Clinical Department of Anaesthesia and Intensive Care and the Surgical Departments of the SCJU Sibiu, with the diagnosis of acute pancreatitis, were included in this observational prospective study. The cut-off values, the specificity and sensitivity of the prognostic scores were calculated using the receiver operating characteristics (ROC) analysis curves. Results: At a cut-off value of 12 mm Hg IAP max has a sensitivity of 0,75, similar to Ranson score at 48 h (0.72 at a cut-off value 3) and CTSI (0,73 at a cut-off value 4). Better results are just for APACHE II score at 24 h (0,88 at a cut-off value 8). IAP max has a specificity of 0,88, simillary to CTSI (0,83) and APACHE II score (0,82). Conclusions: In our study maximum IAP could be correlated with prognostic markers for severe evolution in acute pancreatitis.

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Decreased Activity of Plasma ADAMTS13 Parallels Enhanced Endotoxemia in Patients with Severe Acute Pancreatitis: Relationship to Multiorgan Failure

Blood ◽

10.1182/blood.v112.11.4541.4541 ◽

2008 ◽

Vol 112 (11) ◽

pp. 4541-4541

Author(s):

Chie Morioka ◽

Masahito Uemura ◽

Tomomi Matsuyama ◽

Masanori Matsumoto ◽

Masao Fujimoto ◽

...

Keyword(s):

Acute Pancreatitis ◽

Severe Acute Pancreatitis ◽

Sofa Score ◽

Multiorgan Failure ◽

Prognostic Indicator ◽

Apache Ii ◽

Apache Ii Score ◽

Healthy Controls ◽

Endotoxin Concentration ◽

Plasma Endotoxin

Abstract Background: Severe acute pancreatitis (SAP) frequently progresses to pancreatitis-associated multiorgan failure (MOF) with high mortality. Decreased plasma ADAMTS13 activity (ADAMTS13:AC) results in the accumulation of unusually large von Willebrand factor multimers (UL-VWFM) and the formation of platelet thrombi, ultimately leading to MOF. We demonstrated that the imbalance between decreased ADAMTS13:AC and increased UL-VWFM could contribute to SAP pathogenesis through enhanced thrombogenesis, and serve as an early prognostic indicator for SAP patients (Scand J Gastroenterol, 2008, 26:1). Endotoxin has been considered to be the principle activator of the systemic inflammatory response syndrome, which predisposes patients for MOF and/or pancreatic necrosis, ultimately leading to SAP. We investigated the relationship of endotoxin to ADAMTS13:AC and its related parameters, and tried to explore their potential role on the development of MOF in patients with SAP. Methods: We sequentially determined plasma endotoxin concentration, ADAMTS13:AC and its related parameters in 13 SAP patients (APACHE-II score mean 6.6 ± 2.7), who were admitted into intensive care unit of our hospital between 2004 and 2006. Eleven patients were survivors and two were non-survivors whose APACHE II scores were 10 and 12 died of MOF, respectively. The degree of MOF was evaluated according to the SOFA score. Endotoxin concentration was determined by a chromogenic substrate assay (Toxicolor LS –M Set, Seikagaku Kogyo Co.) with kinetic analysis after pretreatment with detergent, Triton X-100, and heating at 70 °C for 10 min. Plasma ADAMTS13:AC was determined by a sensitive chromogenic ELISA (ADAMTS13-act-ELISA: Kainos Inc.). Plasma UL-VWFM was analyzed by a vertical SDS-1.0% agarose gel electrophoresis. Plasma VWF antigen (VWF:AG), interleukin 6 (IL-6), interleukin 8 (IL-8), and tumor necrosis factor -α (TNF-α) were measured by ELISA. Results: In normal healthy controls (n=20), plasma endotoxin concentration was 7.9±1.7 pg/ml (mean ± SD). The concentration in the SAP patients significantly increased at day 1 (means 65 pg/ml, p<0.001) and at day 2 (88 pg/ml, p<0.001) as compared to healthy controls. The values, thereafter, gradually decreased in 8 survivors (55 pg/ml at day 5, 53 pg/ml at day 7, 27 pg/ml at day 14), while in remaining 3 survivors needing necrosectomy, the concentration further increased (98 pg/ml at day 5, 178 pg/ml at day 7), and decreased to 20 pg/ml at day 14 at the recovery phase. In two non-survivors, the endotoxin levels increased from 37 pg/ml at day 1 to 462 pg/ml at day 2 in one needing necrosectomy, and showed 51 pg/ml at day 1 in another at the age of 91. Within 1 or 2 days after admission, the ADAMTS13:AC was lower in SAP patients (mean 29%, p<0.001) than in healthy controls (99%), and gradually recovered in the 11 survivors but further decreased in the 2 non-survivors. On admission, VWF:Ag was higher (402%, p<0.001) in SAP patients than controls (100%). VWF:Ag gradually decreased in the survivors, except in the 3 survivors needing a necrosectomy, but remained high in the non-survivors. UL-VWFM positive patients showed lower ADAMTS13:AC (25% vs. 42%, p<0.05) and higher VWF:Ag ( 481% vs. 332%, p<0.05), resulting in higher ratio of VWF:Ag to ADAMTS13:AC (25.2 vs. 9.1, p<0.02), as compared to UL-VWFM negative ones. Patients with higher endotoxin concentration more than 50 pg/ml showed lower ADAMTS13:AC than those without (22% vs. 43%, p<0.05). Plasma endotoxin concentration positively correlated with the ratio of VWF:Ag to ADAMTS13:AC (r=0.732, p<0.005). The SOFA score correlated positively with plasma endotoxin concentration (r=0.604, p<0.03), IL-8 (r=0.843, p<0.001), and the ratio of VWF:Ag to ADAMTS13:AC (r=0.700, p<0.01), and inversely with the ADAMTS13:AC (r= − 0.601, p<0.03). Conclusion. The imbalance between decreased ADAMTS13:AC and increased UL-VWFM is closely related to enhanced endotoxemia, which may contribute to the development of SAP and subsequent MOF through enhanced thrombogenesis.

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Procalcitonin and BISAP score versus c-reactive protein and APACHE II score in early assessment of severity and outcome of acute pancreatitis

Vojnosanitetski pregled ◽

10.2298/vsp1205425b ◽

2012 ◽

Vol 69 (5) ◽

pp. 425-431 ◽

Cited By ~ 12

Author(s):

Mihailo Bezmarevic ◽

Zoran Kostic ◽

Miodrag Jovanovic ◽

Sasa Mickovic ◽

Darko Mirkovic ◽

...

Keyword(s):

Acute Pancreatitis ◽

Severe Form ◽

Apache Ii ◽

Apache Ii Score ◽

Serum Concentrations ◽

Key Factors ◽

Early Assessment ◽

Adequate Treatment ◽

Reactive Protein ◽

Score Apache

Background/Aim. Early assessment of severity and continuous monitoring of patients are the key factors for adequate treatment of acute pancreatitis (AP). The aim of this study was to determine the value of procalcitonin (PCT) and Bedside Index for Severity in Acute Pancreatitis (BISAP) scoring system as prognostic markers in early stages of AP with comparison to other established indicators such as Creactive protein (CRP) and Acute Physiology and Chronic Health Evaluation (APACHE) II score. Methods. This prospective study included 51 patients (29 with severe AP). In the first 24 h of admission in all patients the APACHE II score and BISAP score, CRP and PCT serum concentrations were determined. The values of PCT serum concentrations and BISAP score were compared with values of CRP serum concentrations and APACHE II score, in relation to the severity and outcome of the disease. Results. Values of PCT, CRP, BISAP score and APACHE II score, measured at 24 h of admission, were significantly elevated in patients with severe form of the disease. In predicting severity of AP at 24 h of admission, sensitivity and specificity of the BISAP score were 74% and 59%, respectively, APACHE II score 89% and 69%, respectively, CRP 75% and 86%, respectively, and PCT 86% and 63%, respectively. It was found that PCT is highly significant predictor of the disease outcome (p < 0,001). Conclusion. In early assessment of AP severity, PCT has better predictive value than CRP, and similar to the APACHE II score. APACHE II score is a stronger predictor of the disease severity than BISAP score. PCT is a good predictor of AP outcome.

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