Plasma ADAMTS13 activity parallels the APACHE II score, reflecting an early prognostic indicator for patients with severe acute pancreatitis.
OBJECTIVE
Severe acute pancreatitis (SAP) frequently progresses to pancreatitis-associated multiorgan failure (MOF) with high mortality. Decreased plasma ADAMTS13 activity (ADAMTS13:AC) results in the accumulation of unusually large von Willebrand factor multimers (UL-VWFM) and the formation of platelet thrombi, ultimately leading to MOF. The purpose of the study was to investigate the potential role of ADAMTS13:AC in the severity of SAP.


METHODS
Plasma ADAMTS13:AC and its related parameters were sequentially determined in 13 SAP patients. ADAMTS13:AC was determined by the chromogenic act-ELISA.


RESULTS
Within 1 or 2 days after admission, ADAMTS13:AC was lower in SAP patients (mean 28%) than in healthy controls (99%), and gradually recovered in the 11 survivors but further decreased in the 2 non-survivors. Patients with higher sepsis-related organ failure assessment (SOFA) scores showed lower ADAMTS13:AC than those without these scores. The inhibitor against ADAMTS13 was undetectable. On day 1, von Willebrand factor antigen (VWF:Ag) was higher (402%, p<0.001) in SAP patients than in controls (100%). VWF:Ag gradually decreased in the survivors, except in the 3 patients needing a necrosectomy, but remained high in the non-survivors. ADAMTS13:AC was inversely correlated with the APACHE II score (r=-0.750, p<0.005), and increased plasma concentrations of interleukin 6 (IL-6) and IL-8 at admission. UL-VWFM-positive patients had lower ADAMTS13:AC and decreased serum calcium concentrations, but higher VWF:Ag and IL-8 concentrations than UL-VWFM-negative patients.


CONCLUSIONS
Plasma ADAMTS13:AC was closely related to the APACHE II score. This intimate relationship may serve as an early prognostic indicator for SAP patients. The imbalance between decreased ADAMTS13:AC and increased UL-VWFM could contribute to SAP pathogenesis through enhanced thrombogenesis.
Morioka
Chie
C
Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan.
Uemura
Masahito
M
Matsuyama
Tomomi
T
Matsumoto
Masanori
M
Kato
Seiji
S
Ishikawa
Masatoshi
M
Ishizashi
Hiromichi
H
Fujimoto
Masao
M
Sawai
Masayoshi
M
Yoshida
Motoyuki
M
Mitoro
Akira
A
Yamao
Junichi
J
Tsujimoto
Tatsuhiro
T
Yoshiji
Hitoshi
H
Urizono
Yasuyuki
Y
Hata
Michiaki
M
Nishino
Kenji
K
Okuchi
Kazuo
K
Fujimura
Yoshihiro
Y
Fukui
Hiroshi
H
D051722:ADAM Proteins / Q000097:blood*; D000071120:ADAMTS13 Protein; D018806:APACHE; D000208:Acute Disease; D006801:Humans; D009102:Multiple Organ Failure / Q000097:blood* / Q000175:diagnosis; D010195:Pancreatitis / Q000378:metabolism*; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D014841:von Willebrand Factor / Q000032:analysis
D014841:von Willebrand Factor; D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human