Published online Sep 21, 2022. doi: 10.3748/wjg.v28.i35.5203
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
Acute pancreatitis (AP) is one of the most common causes of abdominal emergencies and is associated with sepsis, organ failure and high mortality rates (up to 35%). AP has diverse clinical manifestations with an unpredictable clinical course. It is necessary to predict the severity of AP rapidly and accurately.
A major challenge in AP is the early identification of patients at high-risk for organ failure and death. However, scoring systems are complicated and time consuming with limited predictive value for the clinical course. Biomarkers are promising for the dynamic prediction of disease severity.
To determine whether the dynamic levels of an emerging biomarker, presepsin, can be used to evaluate the severity of disease course and outcome of AP.
In this prospective and multicentric cohort study, 133 patients with AP were included from January 2018 to September 2019. Clinical severity (mild, moderately severe and severe AP) 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. The patients were followed up for 28 d.
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 acute pancreatitis, Ranson, acute physiology and chronic health evaluation-II, computed tomography severity index and Marshall scores and conventional biomarkers such as procalcitonin and C-reactive protein. 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.
The 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. Both presepsin and clearance rate of presepsin on day 3 may be used as early biomarkers to predict the severity and prognosis of AP.
Prospective cohort studies report the predictive value of presepsin in the severity of AP. Future research should focus on the guiding significance of presepsin in the treatment of AP, such as antibiotic use.