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
Processing time: 101 Days and 5 Hours
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research 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 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.

Research conclusions

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.

Research perspectives

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.