Recently, an increasing interest has been extended to the secretory products of fat tissue adipokines and their role in the course of acute pancreatitis (AP). The study aimed to evaluate the levels ...of adiponectin (ADP), adipocyte fatty acid binding protein (A-FABP), fibroblast growth factor (FGF 21), and selected proinflammatory markers during the early stage of acute pancreatitis. The parameters were measured for identification of the patients with the high risk of severe AP.
84 subjects (47 males, 37 females) with AP were divided into the subgroups according to body mass index (BMI), disease severity score (mild AP vs. severe AP) and computer tomography severity index score (CTSI A vs. CTSI B vs. CTSI C). All laboratory examinations were determined on day 1 and day 4 after admission. Adipokines were analyzed using the ELISA kit methods.
No significant variance was found in adipokine levels between subjects with mild and severe AP, but C-reactive protein (CRP) and interleukin 6 (IL-6) were significantly elevated in patients with severe AP on day 4 (CRP medians: 209.8 mg/L vs. 51.2 mg/L, p < 0.000; IL-6 medians: 79.5 ng/L vs. 25.9 ng/L, p < 0.01). FGF 21 medians were distinctly higher on day 1 in all observed subgroups compared to day 4 (mild AP: 669.9 ng/L vs. 261.7 ng/L; severe AP: 619.4 ng/L vs. 468.0 ng/L; CTSI A: 631.4 ng/L vs. 246.2 ng/L; CTSI B: 2226.3 ng/L vs. 693.1 ng/L; CTSI C: 572.6 ng/L vs. 310.8 ng/L). Similarly, this phenomenon was found for A-FABP and IL-6 as well. A-FABP and FGF 21 levels decreased during the first four days together, but independently of the IL-6 decline, regardless of AP severity.
Elevated levels of CRP and IL-6 in subjects with severe form of AP on day 4 indicate a diagnostic utility of both parameters in the disease severity prediction. Increased FGF 21 at admission compared to day 4 suggests its potential role as an immediate response gene during pancreatic injury. The dynamics of FGF 21 and A-FABP levels probably reflect the improvement of clinical condition in the early stage of AP.
Objective: The study aimed to evaluate plasma adiponectin (ADP), adipocyte fatty acid binding protein (A-FABP) and fibroblast growth factor 21 (FGF 21) levels as potential predictors of severity of ...acute pancreatitis (AP) in day 4 after admission. Simultaneously, the classical proinflammatory makers were analysed as well. Settings: Department of Clinical Biochemistry and 2nd Department of Internal Medicine, Faculty Hospital Olomouc, I. P. Pavlova 6, 775 20 Olomouc, Czech Republic; Hospital Písek, Karla Čapka 589, 397 23 Písek, Czech Republic. Study design: The study was conducted in subjects with acute pancreatitis (n = 84, 37 females, 47 males). The analyses were performed in the groups according to the mild/severe classification of AP, and partly in the computed-tomography severity index (CTSI) score subgroups. Results: From adipokines, only FGF 21 tended to be higher in the severe AP subgroup in day 4. The multiple regression analysis revealed a positive association of A-FABP with procalcitonin (PCT), whilst FGF 21 was associated positively with ADP and negatively with C-reactive protein (CRP) in patients with the severe AP. The receiver-operator characteristics (ROC) analysis confirmed that not adipokines, but only CRP and interleukin 6 (IL-6) were suitable as potential predictors of the disease severity. The cut-off values were established for both parameters: 100 mg/L for CRP and 37 ng/L for IL-6, with negative predictive values (NPV) 96 % and 92 %, and positive predictive values (PPV) 39 % and 29 %, respectively. Conclusion: The role of ADP, A-FABP and FGF 21 has been limited in a prediction of the disease severity in day 4 after admission, while CRP and IL-6 might be useful to exclude a severe AP.
Cíle studie: Studie byla zaměřena na vyhodnocení sérových hladin adiponektinu (ADP), adipocytárního proteinu vázajícího mastné kyseliny (A-FABP) a fibroblastového růstového faktoru 21 jako potenciálních prediktorů závažnosti akutní pankreatitidy (AP) 4. den po přijetí. Současně byly stanoveny vybrané klasické prozánětlivé markery. Název a sídlo pracoviště: Oddělení klinické biochemie a II. interní klinika Fakultní nemocnice Olomouc, I. P. Pavlova 6, 775 20 Olomouc; Nemocnice Písek, Karla Čapka 589, 397 23 Písek. Materiál a metody: Studie byla provedena u pacientů s akutní pankreatitidou (n = 84, 37 žen, 47 mužů). Laboratorní markery byly měřeny v podskupinách podle klasifikace lehká/ těžká AP, a částečně také v podskupinách vytvořených na základě CTSI (computed-tomography severity index) skóre. Výsledky: Ze sledovaných adipokinů měl u pacientů s těžkou AP pouze FGF 21 tendenci k vyšším hladinám v den 4 po přijetí. Za pomoci mnohočetné regresní analýzy byla zjištěna pozitivní asociace A-FABP s prokalcitoninem (PCT), zatímco FGF 21 asocioval u těžké AP pozitivně s ADP a negativně s C-reaktivním proteinem (CRP). ROC (receiver-operator characteristics) analýza potvrdila, že pouze CRP a interleukin 6 (IL-6) jsou využitelné jako potenciální prediktory závažnosti onemocnění. Pro oba parametry byly stanoveny cut-off hodnoty: 100 mg/l pro CRP a 37 ng/l pro IL-6, s negativními prediktivními hodnotami (NPV) 96 % a 92 %, a s pozitivními prediktivními hodnotami (PPV) 39 % a 29 %. Závěr: Ve studii jsme zjistili, že hladiny ADP, A-FABP a FGF 21 nejsou vhodnými parametry pro predikci tíže AP 4. den po přijetí. Naopak stanovení CRP a IL-6 v tento den by mohlo být vhodné zejména pro vyloučení těžké akutní pankreatitidy.
Novotny D., Malina P., Krumpholcova P., Tozzi I., Prochazka V.
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