Plasma level of thrombomodulin is an early indication of pancreatic necrosis in patients with acute pancreatitis.
BACKGROUND
The potential to predict pancreatic necrosis within the first 48 h by using plasma soluble thrombomodulin (sTM) in 104 patients with acute pancreatitis (AP) was analyzed in a prospective 5-year investigation performed at a single institution.


METHODS
According to Balthazar CT grade, pancreatitis was classified as no necrosis in 72 patients, one-third necrotic in 18 patients, one-half necrotic in 10 patients and more than one-half necrotic in 4 patients. Blood was collected at the first 48 hours after the onset of pain and analyzed for sTM.


RESULTS
In the healthy volunteers, plasma levels of TM were 16.49+/-5.24 microg/L. By comparison, the mean plasma levels of TM in each group of pancreatitis patients were as follows: CT grade A group, 34.21+/-10.73 microg/L; CT grade B group, 36.18+/-12.50 microg/L; CT grade C group, 49.39+/-18.38 microg/L; CT grade D group, 114.46+/-39.44 microg/L; CT grade E group, 100.22+/-15.97 microg/L (p<0.01). And for the patients, the Pearson correlation coefficient between the CT grade and TM values was 0.784 (p<0.01). No necrosis group, 39.22+/-13.75 microg/L; one-third necrotic group, 71.44+/-18.02 microg/L; one-half necrotic group, 123.50+/-28.57 microg/L; more than one-half necrotic group, 129.00+/-33.28 microg/L (p<0.01); And for the patients, the Pearson correlation coefficient between the degree of necrosis and TM values was 0.888 (p<0.01). ROC analysis indicated the area under the ROC curve (AUC +/- SE) for sTM was 0.949+/-0.020, clearly supportive of the high accuracy of this index in predicting the necrosis of AP.


CONCLUSIONS
Plasma soluble thrombomodulin (sTM) is a potential marker to predict pancreatic necrosis within the first 48 h, and further investigation in a multicentre study is necessary.
Lu
Xin-Liang
XL
Department of Gastroenterology, Second Affiliated Hospital, Hangzhou.
Cai
Jian-Ting
JT
Lu
Xing-Guo
XG
Si
Jian-Min
JM
Qian
Ke-Da
KD
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010179:Pancreas / Q000473:pathology*; D019283:Pancreatitis, Acute Necrotizing / Q000097:blood* / Q000473:pathology*; D011446:Prospective Studies; D018180:Thrombomodulin / Q000097:blood*
D015415:Biomarkers; D018180:Thrombomodulin