Brief Article
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World J Gastroenterol. Dec 7, 2012; 18(45): 6620-6627
Published online Dec 7, 2012. doi: 10.3748/wjg.v18.i45.6620
Value of adipokines in predicting the severity of acute pancreatitis: Comprehensive review
Andrius Karpavicius, Zilvinas Dambrauskas, Audrius Sileikis, Dalius Vitkus, Kestutis Strupas
Andrius Karpavicius, Audrius Sileikis, Kestutis Strupas, Clinic of Gastroenterology, Nephrology, Urology and Surgery, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania
Andrius Karpavicius, Audrius Sileikis, Kestutis Strupas, Center of Abdominal Surgery, Vilnius University Hospital “Santariskiu klinikos”, LT-08661 Vilnius, Lithuania
Zilvinas Dambrauskas, Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania
Zilvinas Dambrauskas, Institute for Research of Digestive System, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania
Dalius Vitkus, Department of Physiology, Biochemistry, Microbiology, and Laboratory Medicine, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania
Author contributions: Karpavicius A, Dambrauskas Z and Vitkus D performed the database search and quality assessment, analyzed and interpreted the data, drafted the manuscript; Dambrauskas Z and Sileikis A drafted the study concept and design; Strupas K supervised the study and critically revisited the manuscript for important intellectual content.
Correspondence to: Andrius Karpavicius, MD, Center of Abdominal Surgery, Vilnius University Hospital “Santariskiu klinikos”, Santariskiu 2, LT-08661 Vilnius, Lithuania. andrius.karpavicius@gmail.com
Telephone: +370-614-35747 Fax: +370-5-2365101
Received: July 10, 2012
Revised: September 18, 2012
Accepted: September 22, 2012
Published online: December 7, 2012
Abstract

AIM: To analyze the prognostic value of adipokines in predicting the course, complications and fatal outcome of acute pancreatitis (AP).

METHODS: We performed the search of PubMed database and the systemic analysis of the literature for both experimental and human studies on prognostic value of adipokines in AP for period 2002-2012. Only the papers that described the use of adipokines for prediction of severity and/or complications of AP were selected for further analysis. Each article had to contain information about the levels of measured adipokines, diagnosis and verification of AP, to specify presence of pancreatic necrosis, organ dysfunction and/or mortality rates. From the very beginning, study was carried out adhering to the PRISMA checklist and flowchart for systemic reviews. To assess quality of all included human studies, the Quality Assessment of Diagnostic Accuracy Studies tool was used. Because of the high heterogeneity between the studies, it was decided to refrain from the statistical processing or meta-analysis of the available data.

RESULTS: Nine human and three experimental studies were included into review. In experimental studies significant differences between leptin concentrations at 24 and 48 h in control, acute edematous and acute necrotizing pancreatitis groups were found (P = 0.027 and P < 0.001). In human studies significant differences between leptin and resitin concentrations in control and acute pancreatitis groups were found. 1-3 d serum adiponectin threshold of 4.5 μg/mL correctly classified the severity of 81% of patients with AP. This threshold yielded a sensitivity of 70%, specificity 85%, positive predictive value 64%, negative predictive value88% (area under curve 0.75). Resistin and visfatin concentrations differ significantly between mild and severe acute pancreatitis groups, they correlate with severity of disease, need for interventions and outcome. Both adipokines are good markers for parapancreatic necrosis and the cut-off values of 11.9 ng/mL and 1.8 ng/mL respectively predict the high ranges of radiological scores. However, the review revealed that all nine human studies with adipokines are very different in terms of methodology and objectives, so it is difficult to generalize their results. It seems that concentrations of the leptin and resistin increases significantly in patients with acute pancreatitis compared with controls. Serum levels of adiponectin, visfatin and especially resitin (positive correlation with Acute Physiology and Chronic Health Evaluation II, Ranson and C-reactive protein) are significantly different in mild acute pancreatitis and severe acute pancreatitis patients, so, they can serve as a markers for the disease severity prediction. Resistin and visfatin can also be used for pancreatic and parapancreatic necrosis prediction, interventions needs and possible, outcome.

CONCLUSION: High levels of adipokines could allow for prediction of a severe disease course and outcome even in small pancreatic lesions on computed tomography scans.

Keywords: Adipokines; Acute; Pancreatitis; Severity; Prediction