title: Activated protein C-protein C inhibitor complex, activation peptide of carboxypeptidase B and C-reactive protein as predictors of severe acute pancreatitis.
abstract: BACKGROUND
  The concentration of carboxypeptidase B activation peptide (CAPAP) is proposed to be a predictor of severe acute pancreatitis. The activated protein C (APC)-protein C inhibitor (PCI; APC-PCI) complex in plasma could be useful in detecting the hypercoagulative condition in severe acute pancreatitis.
  
  
  METHODS
  In this prospective study, mild (n = 50) and severe (n = 9) cases of acute pancreatitis were compared with respect to levels of CAPAP and APC-PCI, and sorted in time intervals from onset of symptoms to sampling. The peak values of the C-reactive protein (CRP) within the 1st week were also compared.
  
  
  RESULTS
  CRP detected the severe cases with a sensitivity of 0.89 and a specificity of 0.74 (cut-off level 200 mg/l). In the interval 0-72 h, CAPAP could predict the severity of the disease in serum and urine (sensitivity 0.52/0.29, specificity 0.73/0.93, cut-off 2 nM/60 nM). The level of APC-PCI in plasma could predict the severe condition in the interval 0-24 h after the onset of symptoms (sensitivity 0.6, specificity 0.66, cut-off level 0.54 microg/l).
  
  
  CONCLUSIONS
  Of the parameters explored, CRP is still the best biochemical marker to distinguish between severe and mild acute pancreatitis. CAPAP could be useful in combination with other tests, but the APC-PCI complex's diagnostic time interval is too short to be used in the clinical routine.
authors.affiliation: Department of Surgery, Lund University, Malmö University Hospital, Malmo, Sweden. claes.hjalmarsson@lthalland.se
authors.forename: Claes
authors.initials: C
authors.lastname: Hjalmarsson
authors.forename: Johan
authors.initials: J
authors.lastname: Stenflo
authors.forename: Anders
authors.initials: A
authors.lastname: Borgström
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D043424:Carboxypeptidase B / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood* / Q000175:diagnosis; D019283:Pancreatitis, Acute Necrotizing / Q000097:blood / Q000175:diagnosis; D010455:Peptides / Q000097:blood*; D011486:Protein C / Q000378:metabolism*; D018046:Protein C Inhibitor / Q000097:blood*
chemical_list: D015415:Biomarkers; D010455:Peptides; D011486:Protein C; D018046:Protein C Inhibitor; C110925:carboxypeptidase B activation peptide; D043424:Carboxypeptidase B