Possibility of prediction of acute pancreatitis severity by determination of adipokines (adiponectin, FGF-21 and A-FABP) during hospitalization
Authors:
P. Malina 1; D. Novotný 2; P. Krumpholcova 3; I. Tozzi 3; V. Procházka 3
Authors‘ workplace:
Oddělení klinické biochemie Nemocnice Písek, a. s.
1; Oddělení klinické biochemie Fakultní nemocnice Olomouc
2; II. interní gastroenterologická a hepatologická klinika Fakultní nemocnice Olomouc
3
Published in:
Klin. Biochem. Metab., 22 (43), 2014, No. 1, p. 16-21
Overview
Objective:
Acute pancreatitis (AP) is a serious disease with relatively high mortality of severe form. The treatment of mild form differs from the therapy of severe form and thus their early discrimination is highly desirable. Different scoring systems and laboratory markers were developed for this purpose. Because obesity is a risk factor for acute pancreatitis and also predicts more severe course, the attention in this direction is focused to adipokines as mediators derived from adipose tissue. The aim of study was to recognize if admission values of these markers – Adiponectin (ADP), Fibroblasts growth factor 21 (FGF-21), Adipocyte-fatty acids binding protein (A-FABP) – correlate with the severity of acute pancreatitis determined by CT examination.
Design:
Prospective observational.
Settings:
Department of Clinical Chemistry, Hospital Písek; Department of Clinical Chemistry, Teaching hospital Olomouc
Material and Methods:
54 patients with acute pancreatitis were included into study, CT was available in 47 of them. Patients were scored with CT using Balthazar`s score, necrosis score and CT severity index (CTSI). Venous samples on the day of admission were taken in all patients (clottable blood), from which following markers were analyzed: FGF-21, ADP, A-FABP. Correlation of adipokines levels with CTSI was done, patients were divided into two groups – mild AP (CTSI score 0-5 points) and severe AP (CTSI score 6-10 points) and the statistical comparison of both groups using Kruskal-Wallis test was performed (MedCalc software, Ostend, Belgium).
Results:
Adiponectin admission levels in the group of patients with mild AP were 6.4 (5.23 - 9.28) mg/l; median (interquartile range), in the group of severe AP 8.45 (7.10 - 9.20) mg/l. A-FABP levels in the group of patients with mild AP were 28.0 (17.6 – 40.2) µg/l, in the severe AP group 28.7 (17.6 – 40.2) µg/l. FGF-21 levels in the group with mild AP were 666 (213 - 2379) ng/l, in the group with severe AP 522 (308 - 868) ng/l. None of these adipokines showed statistically significant difference between the group of mild AP and severe AP (for Adiponectin p=0.215, for A-FABP p=0.794, for FGF-21 p=0.458). When patients were divided into 3 categories using CTSI score – category A with 0 – 2 points (very mild pancreatitis), category B with 3 – 5 points (mild pancreatitis) and category C with 6 – 10 points (severe pancreatitis), statistically significant difference was not found for Adiponectin (p=0.076) and for A-FABP (p=0.842). For FGF-21 statistically significant difference was found between categories A vs. B and between B vs. C (p=0.014).
Conclusion:
Admission levels of Adiponectin, FGF-21 and A-FABP did not correlate with severity of AP set by CT examination using CTSI index. Differences of adiponectin, FGF-21 and A-FABP at admission were not significant between patients with mild and severe pancreatitis, respectively. This implies that the values of Adiponectin, FGF-21 and A-FABP on admission in patients with acute pancreatitis can not be used to estimate the severity of the course of acute pancreatitis. However, some statistically significant differentiation for a more detailed breakdown of patients into 3 groups according to CTSI was found in FGF-21 indicating its positive potential and it will require more extensive study. Further research is also required for dynamic of adipokines´ values during hospitalization.
Keywords:
acute pancreatitis, adipokines, severity prediction, adiponectin, A-FABP, FGF-21.
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