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Multicenter Study
. 2016 Aug 22;16(1):99.
doi: 10.1186/s12876-016-0514-4.

The clinical value of adipokines in predicting the severity and outcome of acute pancreatitis

Andrius Karpavicius  1   2 , Zilvinas Dambrauskas  3   4 , Audrius Gradauskas  5   6 , Arturas Samuilis  7 , Kristina Zviniene  8 , Juozas Kupcinskas  9 , Gintautas Brimas  10 , Artur Meckovski  10 , Audrius Sileikis  11 , Kestutis Strupas  11
Affiliations
Multicenter Study

The clinical value of adipokines in predicting the severity and outcome of acute pancreatitis

Andrius Karpavicius et al. BMC Gastroenterol. .

Abstract

Background: Recent 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).

Methods: Prospective 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.

Results: Forty 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.

Conclusions: The 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.

Keywords: Acute pancreatitis; Adipokines; Adiponectin; Leptin; Prediction; Prognosis; Resistin; Severity; Visfatin.

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Figures

Fig. 1
Fig. 1
The flowdiagram for patient’s selection. Abbreviations: CT – Computed Tomography; AP – Acute Pancreatitis; MAP – Mild Acute Pancreatitis; MSAP - Moderately severe acute pancreatitis; SAP – Severe Acute Pancreatitis
Fig. 2
Fig. 2
Prognostic value of admission resistin and IL-6 levels for development of SAP. IL-6 cut-off value 473.4 pg/ml predicts SAP (sens. 82.9 %, spec. 75.0 %, PPV 51.7 %, NPV 93.2 %, AUC 0.78). Resistin cut-off value 13.7 ng/ml predicts SAP (sens. 63.4 %, spec. 80.0 %, PPV 34,8 %, NPV 92,9 %, AUC 0.76). Abbreviations: IL-6 – Interleukin-6; AUC - area under the curve
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