Admission resistin levels predict peripancreatic necrosis and clinical severity in acute pancreatitis.
OBJECTIVE
Peripancreatic necrosis determines clinical severity in acute pancreatitis. Early markers predicting peripancreatic necrosis and clinical severity are lacking. Because adipocytes of peripancreatic adipose tissue secret highly active adipocytokines, the aim of the study was to investigate whether adipocytokines are able to serve as early markers predicting peripancreatic necrosis and clinical severity.


METHODS
A total of 50 patients (20 women, 30 men) with acute pancreatitis were included in this noninterventional, prospective, and monocentric cohort study on diagnostic accuracy. Clinical severity was classified by the Ranson score and the APACHE (Acute Physiology And Chronic Health Evaluation) II score. Pancreatic and peripancreatic necrosis were quantified by using the computed tomography-based Balthazar score, the Schroeder score, and the pancreatic necrosis score. Adiponectin, leptin, and resistin were measured at admission and daily for at least 10 days by enzyme-linked immunosorbent assay.


RESULTS
In contrast to admission C-reactive protein values, admission resistin values were significantly correlated with clinical severity and even with clinical end points such as death and need for interventions. Admission resistin levels were significantly elevated in patients with higher pancreatic and extrapancreatic necrosis scores. It was shown by receiver-operator characteristics that admission resistin concentration provides a positive predictive value of 89% in predicting the extent of peripancreatic necrosis (area under the curve, 0.8; P=0.002; sensitivity, 80%; specificity, 70%) by using a cutoff value of 11.9 ng/ml.


CONCLUSIONS
Admission resistin concentration serves as an early predictive marker of peripancreatic necrosis and clinical severity in acute pancreatitis. Resistin may have potential for clinical use as a new and diagnostic serum marker.
Schäffler
Andreas
A
Department of Internal Medicine I, University Hospital of Regensburg, Regensburg, Germany. andreas.schaeffl er@klinik.uni-regensburg.de
Hamer
Okka
O
Dickopf
Judith
J
Goetz
Andrea
A
Landfried
Karin
K
Voelk
Markus
M
Herfarth
Hans
H
Kopp
Andrea
A
Büchler
Christa
C
Schölmerich
Jürgen
J
Brünnler
Tanja
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology*; D019283:Pancreatitis, Acute Necrotizing / Q000097:blood* / Q000000981:diagnostic imaging / Q000473:pathology; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D011859:Radiography; D052243:Resistin / Q000097:blood*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
D052243:Resistin