Significance of endothelial molecular markers in the evaluation of the severity of acute pancreatitis.
OBJECTIVE
In acute pancreatitis, neutrophil elastase is secreted which damages the endothelial cells. This study was designed to demonstrate that the plasma levels of soluble E-selectin (sES) and soluble thrombomodulin (sTM) serve as endothelial molecular markers; the former is used as an endothelial activation marker, while the latter, as an endothelial injury marker.


METHODS
A total of 27 acute pancreatitis patients were enrolled. The plasma sES and sTM levels were assessed for 10 days after admission.


RESULTS
The plasma sES levels of all the patients in different disease stages were elevated at the time of admission day (day 1). The plasma sTM levels correlated with the severity and prognosis of acute pancreatitis. The required cutoff to predict a fatal outcome was set as 32 Teijin Units (TU)/ml (sensitivity, 80%; specificity, 91%). On day 1, the mortality rate of patients with the sTM levels of > or = 32 TU/ml (67%, 4/6) was significantly higher than of those with the sTM levels of <32 TU/ml (5%, 1/21).


CONCLUSIONS
These results indicated that (1) the activation of the vascular endothelial cells and the resultant increase in the plasma sES levels might be evoked in all disease stages, and (2) an elevation of the plasma sTM level, which indicates the presence of vascular endothelial injury, might therefore result in a poor prognosis.
Ida
Satoshi
S
Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Kumamoto 860-8556, Japan.
Fujimura
Yoshinori
Y
Hirota
Masahiko
M
Imamura
Yu
Y
Ozaki
Nobuyuki
N
Suyama
Koichi
K
Hashimoto
Daisuke
D
Ohmuraya
Masaki
M
Tanaka
Hiroshi
H
Takamori
Hiroshi
H
Baba
Hideo
H