Evaluation of Prognostic Factors of Severity in Acute Biliary Pancreatitis

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Abstract

Acute pancreatitis (AP) is an inflammatory disorder of the pancreas that, when classified as severe, is associated with high morbidity and mortality. Promptly identifying the severity of AP is of extreme importance for improving clinical outcomes. The aim of this study was to compare the prognostic value of serological biomarkers, ratios, and multifactorial scores in patients with acute biliary pancreatitis and to identify the best predictors. In this observational and prospective study, the biomarkers, ratios and multifactorial scores were evaluated on admission and at 48 h of the symptom onset. On admission, regarding the AP severity, the white blood count (WBC) and neutrophil–lymphocyte ratio (NLR), and regarding the mortality, the WBC and the modified Marshall score (MMS) showed the best predictive values. At 48 h, regarding the AP severity, the hepcidin, NLR, systemic inflammatory response index (SIRI) and MMS and regarding the mortality, the NLR, hepcidin and the bedside index for severity in AP (BISAP) score, showed the best predictive values. The present study enabled the identification, for the first time, of SIRI as a new prognostic tool for AP severity, and validated hepcidin and the NLR as better prognostic markers than C-reactive protein (CRP) at 48 h of symptom onset.

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Interleukin-6 induces hepcidin expression through STAT3.

Diedra M Wrighting, Nancy C Andrews (2006)

Iron homeostasis is maintained through meticulous regulation of circulating hepcidin levels. Hepcidin levels that are inappropriately low or high result in iron overload or iron deficiency, respectively. Although hypoxia, erythroid demand, iron, and inflammation are all known to influence hepcidin expression, the mechanisms responsible are not well defined. In this report we show that the inflammatory cytokine interleukin-6 (IL-6) directly regulates hepcidin through induction and subsequent promoter binding of signal transducer and activator of transcription 3 (STAT3). STAT3 is necessary and sufficient for the IL-6 responsiveness of the hepcidin promoter. Our findings provide a mechanism by which hepcidin can be regulated by inflammation or, in the absence of inflammatory stimuli, by alternative mechanisms leading to STAT3 activation.

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LEAP-1, a novel highly disulfide-bonded human peptide, exhibits antimicrobial activity.

A. Krause, S Neitz, H Mägert … (2000)

We report the isolation and characterization of a novel human peptide with antimicrobial activity, termed LEAP-1 (liver-expressed antimicrobial peptide). Using a mass spectrometric assay detecting cysteine-rich peptides, a 25-residue peptide containing four disulfide bonds was identified in human blood ultrafiltrate. LEAP-1 expression was predominantly detected in the liver, and, to a much lower extent, in the heart. In radial diffusion assays, Gram-positive Bacillus megaterium, Bacillus subtilis, Micrococcus luteus, Staphylococcus carnosus, and Gram-negative Neisseria cinerea as well as the yeast Saccharomyces cerevisiae dose-dependently exhibited sensitivity upon treatment with synthetic LEAP-1. The discovery of LEAP-1 extends the known families of mammalian peptides with antimicrobial activity by its novel disulfide motif and distinct expression pattern.

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The early prediction of mortality in acute pancreatitis: a large population-based study.

B Wu, R S Johannes, X. Sun … (2008)

Identification of patients at risk for mortality early in the course of acute pancreatitis (AP) is an important step in improving outcome. Using Classification and Regression Tree (CART) analysis, a clinical scoring system was developed for prediction of in-hospital mortality in AP. The scoring system was derived on data collected from 17,992 cases of AP from 212 hospitals in 2000-2001. The new scoring system was validated on data collected from 18,256 AP cases from 177 hospitals in 2004-2005. The accuracy of the scoring system for prediction of mortality was measured by the area under the receiver operating characteristic curve (AUC). The performance of the new scoring system was further validated by comparing its predictive accuracy with that of Acute Physiology and Chronic Health Examination (APACHE) II. CART analysis identified five variables for prediction of in-hospital mortality. One point is assigned for the presence of each of the following during the first 24 h: blood urea nitrogen (BUN) >25 mg/dl; impaired mental status; systemic inflammatory response syndrome (SIRS); age >60 years; or the presence of a pleural effusion (BISAP). Mortality ranged from >20% in the highest risk group to <1% in the lowest risk group. In the validation cohort, the BISAP AUC was 0.82 (95% CI 0.79 to 0.84) versus APACHE II AUC of 0.83 (95% CI 0.80 to 0.85). A new mortality-based prognostic scoring system for use in AP has been derived and validated. The BISAP is a simple and accurate method for the early identification of patients at increased risk for in-hospital mortality.

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Journal

Journal ID (nlm-ta): Int J Mol Sci

Journal ID (iso-abbrev): Int J Mol Sci

Journal ID (publisher-id): ijms

Title: International Journal of Molecular Sciences

Publisher: MDPI

ISSN (Electronic): 1422-0067

Publication date (Electronic): 16 June 2020

Publication date Collection: June 2020

Volume: 21

Issue: 12

Electronic Location Identifier: 4300

Affiliations

[1 ]Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal; mcbranco@ 123456fcsaude.ubi.pt

[2 ]General Surgery Department, Hospital Amato Lusitano, Unidade Local de Saúde de Castelo Branco, 6000-085 Castelo Branco, Portugal; agouveia@ 123456ulscb.min-saude.pt

[3 ]Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal

[4 ]Clinical Academic Centre of Beiras, CACB, 6200-506 Covilhã, Portugal; sara@ 123456ipcb.pt

[5 ]Biophysics Institute, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; mabrantes@ 123456fmed.uc.pt (A.M.A.); mfbotelho@ 123456fmed.uc.pt (M.F.B.); jglrt@ 123456hotmail.com (J.G.T.)

[6 ]Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal

[7 ]CNC.IBILI Consortium/Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal

[8 ]Clinical Academic Center of Coimbra, CACC, 3004-561 Coimbra, Portugal

[9 ]Polytechnic Institute of Castelo Branco, Escola Superior de Gestão, 6000-084 Castelo Branco, Portugal

[10 ]Surgery Department, Centro Hospitalar e Universitário de Coimbra (CHUC), University Hospital, Faculty of Medicine, 3000-075 Coimbra, Portugal

Author notes

[* ]Correspondence: pedro.silvavaz@ 123456gmail.com ; Tel.: +351-966-498-337

Author information

Pedro Silva-Vaz https://orcid.org/0000-0002-2979-1024

Sara Morgado-Nunes https://orcid.org/0000-0003-2944-306X

Maria Filomena Botelho https://orcid.org/0000-0001-7202-1650

Article

Publisher ID: ijms-21-04300

DOI: 10.3390/ijms21124300

PMC ID: 7352282

PubMed ID: 32560276

SO-VID: e9edcf34-ba12-4413-8a0f-56ee5a6df293

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Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

Evaluation of Prognostic Factors of Severity in Acute Biliary Pancreatitis

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Biomarkers for Inflammatory Lung Disease

Most cited references 49

Interleukin-6 induces hepcidin expression through STAT3.

LEAP-1, a novel highly disulfide-bonded human peptide, exhibits antimicrobial activity.

The early prediction of mortality in acute pancreatitis: a large population-based study.

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