#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

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.


Sources

1. Mitchell, R. M. S., Byrne, M. F., Baillie, J. Pancreatitis. Lancet, 2003, 361, p. 1447–55.

2. Sandberg, A. A., Borgström, A. Early prediction of severity in acute pancreatitis. Is this possible? JOP, 2002, 3, p. 116–25.

3. Papachristou, G. I., Whitcomb, D. C. Predictors of severity and necrosis in acute pancreatitis. Gastroenterol. Clin. North Am., 2004, 33, p. 871–90.

4. Johnson, C. D., Toh, S. K. C., Campbel, M. J. Combination of APACHE-II score and an obesity score (APACHE-O) for the prediction of severe acute pancrea-titis. Pancreatology, 2002, 4, p. 1–6.

5. Mentula, P., Kylänpää, M. L., Kemppainen, E. et al. Early prediction of organ failure by combined markers in patients with acute pancreatitis. Br. J. Surg., 2005, 92, p. 68–75.

6. Banks, P. A., Bollen, T. L., Dervenis, C., Gooszen, H. G., Johnson, C. D., Sarr, M. G., Tsiotos, G. G., Vege, S. S. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus; Acute Pancreatitis Classification Working Group. Gut, 2013, 62 (1), p. 102-11.

7. Toouli, J., Brooke-Smith, M., Bassi, C., Carr-Locke, D., Telford, J., Freeny, P. et al. Guidelines for the ma-nagement of acute pancreatitis. J Gastroenterol. Hepatol., 2002, 17, p. 15-39.

8. Werner, J., Hartwig, W., Uhl, W., Muller, C., Buchler, M. W. Useful markers for predicting severity and monitoring progression of acute pancreatitis. Pancreatology, 2003, 3, p. 115-27.

9. Zadák, Z., Havel, E. Intenzivní medicína na principech vnitřního lékařství. Praha, Grada, 2007, 335 s., ISBN 978-80-247-2099-9

10. Tenner, S., Baillie, J., DeWitt, J., Vege, S. S. American College of Gastroenterology guideline: management of acute pancreatitis; American College of Gastroentero-logy. Am. J. Gastroenterol., 2013, 108 (9), p. 1400-1416

11. Lankisch, P. G., Schirren, C. A. Increased body weight as a prognostic parameter for complications in the course of acute pancreatitis. Pancreas, 1990, 5, p. 262–629.

12. Porter, K. A., Banks, P. A. Obesity as a predictor of severity in acute pancreatitis. Int. J. Pancreatol., 1991, 10, p. 247–52.

13. Schäffler, A., Schölmerich, J., Büchler, C. Adipocytokines and visceral adipose tissue. Emerging role in intestinal and mesenteric diseases. Nat. Clin. Prac. (Gastroenterol. Hepatol.), 2005, 2, p. 103–11.

14. Smitka, K. Adipokiny a hormonální funkce tukové tkáně; Česká kinantropologie, 2011, 15, 1, p. 9–14

15. Wozniak, S. E., Gee, l. L., Wachtel, M. S., Frezza, E. E. Adipose tissue: The new endocrine organ? A review article. Dig. Dis. Sci., 2009, 54, p. 1847–1856.

16. Novotný, D., Vaverková, H., Karásek, D., Halenka, M. Adiponektin – parametr s protizánětlivým a proti-aterogenním potenciálem. Klin. Biochem. Metab., 2008, 16 (37), No. 3, p. 171-177.

17. Li, F. Y., Cheng, K. K., Lam, K. S., Vanhoutte, P. M., Xu, A. Cross-talk between adipose tissue and vasculature: role of adiponectin. Acta Physiol. (Oxf). 2011, 203(1), p. 167-80.

18. Kharitonenkov, A. et al. FGF-21 as a novel metabolic regulator. J Clin. Invest., 2005, 115(6), p. 1627–1635.

19. Makowski, L., Hotamisligil, G. S. Fatty acid binding proteins – the evolutionary crossroads of inflammatory and metabolic responses. J Nutr., 2004, 134, p. 2464–2468.

20. Furuhashi, M., Hotamisligil, G. S. Fatty acid-binding proteins: role in metabolic diseases and potential as drug targets. Nat. Rev. Drug. Discov., 2008, 7, p. 489–503.

21. Jenkins-Kruchten, A. E., Bennaars-Eiden, A., Ross, J. R., Shen, W. J., Kraemer, F. B., Bernlohr, D. A. Fatty acid-binding protein-hormone-sensitive lipase interaction. Fatty acid dependence on binding. J Biol. Chem., 2003, 278, p. 47636–47643.

22. Balthazar, E. J. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology, 2002, 223, p. 603–13.

23. Vriens, P. W., van de Linde, P., Slotema, E. T., Warmerdam, P. E., Breslau, P. J. Computed tomo-graphy severity index is an early prognostic tool for acute pancreatitis. J Am. Coll. Surg., 2005, 201 (4), p. 497–502.

24. Sharma, A., Muddana, V., Lamb, J., Greer, J., Papachristou, G. I., Whitcomb, D. C. Low serum adiponectin levels are associated with systemic organ failure in acute pancreatitis. Pancreas, 2009, 38, p. 907-912

25. Schäffler, A., Hamer, O. W., Dickopf, J., Goetz, A., Landfried, K., Voelk, M., Herfarth, H., Kopp, A., Buechler, C., Schölmerich, J., Brünnler, T. Admission visfatin levels predict pancreatic and peripancreatic necrosis in acute pancreatitis and correlate with clinical severity. Am. J Gastroenterol., 2011, 106(5), p. 957-67.

26. Schäffler, A., Hamer, O., Dickopf, J., Goetz, A., Landfried, K., Voelk, M., Herfarth, H., Kopp, A., Büchler, C., Schölmerich, J., Brünnler, T. Admission resistin levels predict peripancreatic necrosis and clinical severity in acute pancreatitis. Am. J Gastroenterol., 2010, 105 (11), p. 2474-84.

27. Schäffler, A., Landfried, K., Völk, M., Fürst, A., Büchler, C., Schölmerich, J., Herfarth, H. Potential of adipocytokines in predicting peripancreatic necrosis and severity in acute pancreatitis: pilot study. J Gastroenterol. Hepatol., 2007, 22(3), p. 326-34.

28. Tukiainen, E., Kylanpaa, M. L., Ebeling, P., Kemppainen, E., Puolakkainen, P., Repo, H. Leptin and adiponectin levels in acute pancreatitis. Pancreas, 2006, 32(2), p. 211-4.

29. Karpavicius, A., Dambrauskas, Z., Sileikis, A., Vitkus, D., Strupas, K. Value of adipokines in predicting the severity of acute pancreatitis: comprehensive review. World J Gastroenterol., 2012, 7, 18(45), p. 6620-7.

30. Konturek, P. C., Jaworek, J., Maniatoglou, A., Bonior, J., Meixner, H., Konturek, S. J., Hahn, E. G. Leptin modulates the inflammatory response in acute pancreatitis. Digestion, 2002, 65, p. 149-160.

Labels
Clinical biochemistry Nuclear medicine Nutritive therapist
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#