Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2022; 28(35): 5203-5216
Published online Sep 21, 2022. doi: 10.3748/wjg.v28.i35.5203
Dynamic blood presepsin levels are associated with severity and outcome of acute pancreatitis: A prospective cohort study
Hong-Li Xiao, Guo-Xing Wang, Yan Wang, Zhi-Min Tan, Jie Zhou, Han Yu, Miao-Rong Xie, Chun-Sheng Li
Hong-Li Xiao, Guo-Xing Wang, Yan Wang, Zhi-Min Tan, Jie Zhou, Miao-Rong Xie, Chun-Sheng Li, Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Han Yu, Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
Author contributions: Xiao HL and Wang GX have contributed equally to this work; Li CS and Xie MR contributed to the study conception and design; Xiao HL, Wang GX, Wang Y, Tan ZM, Zhou J and Yu H participated in the material preparation and data collection; Xiao HL and Wang GX performed the analyses; Xiao HL drafted the initial manuscript and revised the article; All authors read and approved the final manuscript.
Supported by Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support “Yangfan” Project, No. ZYLX201802; Beijing Municipal Administration of Hospitals' Youth Program, No. QML20170105; and National Natural Science Foundation of China, No. 81374004 and 81773931.
Institutional review board statement: The study was reviewed and approved by the Ethics Commission of Beijing Friendship Hospital affiliated to Capital Medical University (Approval No. 2017-P2-103-02).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chun-Sheng Li, MD, Professor, Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing 100050, China. lcscyyy@163.com
Received: June 6, 2022
Peer-review started: June 6, 2022
First decision: June 27, 2022
Revised: July 10, 2022
Accepted: September 1, 2022
Article in press: September 1, 2022
Published online: September 21, 2022
Abstract
BACKGROUND

Acute pancreatitis (AP) is an inflammatory disorder of the pancreas with an unpredictable course of illness. A major challenge of AP is the early identification of patients at high-risk for organ failure and death. However, scoring systems are complicated and time consuming, and the predictive values for the clinical course are vague.

AIM

To determine whether the dynamic changes in presepsin levels can be used to evaluate the severity of disease and outcome of AP.

METHODS

In this multicentric cohort study, 133 patients with AP were included. Clinical severity was dynamically evaluated using the 2012 revised Atlanta Classification. Blood presepsin levels were measured at days 1, 3, 5 and 7 after admission by chemiluminescent enzyme immunoassay.

RESULTS

The median concentration of presepsin increased and the clearance rate of presepsin decreased with disease severity and organ failure in AP patients. The presepsin levels on days 3, 5 and 7 were independent predictors of moderately severe and severe AP with time-specific area under the curve (AUC) values of 0.827, 0.848 and 0.867, respectively. The presepsin levels positively correlated with bedside index of severity in AP, Ranson, acute physiology and chronic health evaluation II, computed tomography severity index and Marshall scores. Presepsin levels on days 3, 5 and 7 were independent predictors of 28-d mortality of AP patients with AUC values of 0.781, 0.846 and 0.843, respectively.

CONCLUSION

Blood presepsin levels within 7 d of admission were associated with and may be useful to dynamically predict the severity of disease course and 28-d mortality in AP patients.

Keywords: Presepsin, Acute pancreatitis, Severity, Mortality, Disease severity

Core Tip: Acute pancreatitis has diverse clinical manifestations with an unpredictable clinical course. A major challenge of acute pancreatitis is the early identification of patients at high-risk for organ failure and death. Scoring systems are complicated and time consuming with limited predictive value for the clinical course. In this study, we investigated the association between the dynamic levels of blood presepsin, a new infection biomarker, and the changes of severity in the early course of acute pancreatitis. We found the predictive value of presepsin for 28-d mortality was similar to the bedside index of severity in acute pancreatitis, Ranson and acute physiology and chronic health evaluation II scores.