title: Early angiopoietin-2 levels after onset predict the advent of severe pancreatitis, multiple organ failure, and infectious complications in patients with acute pancreatitis.
abstract: BACKGROUND
  Acute pancreatitis is a severe condition that requires early identification of patients at risk of developing potentially lethal complications. Current clinical scoring systems and biochemical parameters are insufficient. In this study, we aimed to assess whether early plasma Angiopoietin-2 (Ang-2) is associated with adverse outcomes in patients with predicted severe acute pancreatitis (SAP).
  
  
  METHODS
  This analysis is a substudy of the PROPATRIA trial (probiotics vs placebo in patients with predicted SAP). The Ang-2 levels were measured prospectively in plasma in the first 5 days after admission in 115 patients.
  
  
  RESULTS
  Early Ang-2 levels were higher in patients who developed SAP: 6.4 vs 3.1 μg/L (p < 0.001) and also were higher in patients who developed multiorgan failure in the first week (p = 0.001) and after the first week (p = 0.049). Furthermore, high Ang-2 levels were associated with infectious complications in the first week (p < 0.001) and after the first week (p < 0.001). Finally, plasma Ang-2 was significantly higher in patients who died (p < 0.001) and in patients who developed bowel ischemia (p < 0.001). As a predictor of adverse outcomes, plasma Ang-2 was superior to a number of current scores, such as the APACHE II score, the Imrie score, C-reactive protein, lipopolysaccharide binding protein, and procalcitonin.
  
  
  CONCLUSIONS
  In the setting of this randomized controlled trial, early plasma Ang-2 was found to be an accurate predictor of SAP, multiorgan failure, and infectious complications. As a biomarker, it did outperform all of the investigated conventional predictors that are currently used in clinical practice.
authors.affiliation: Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Karel T
authors.initials: KT
authors.lastname: Buddingh
authors.affiliation: Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Lyan G
authors.initials: LG
authors.lastname: Koudstaal
authors.affiliation: Department of Surgery, University Medical Center, Utrecht, The Netherlands.
authors.forename: Hjalmar C
authors.initials: HC
authors.lastname: van Santvoort
authors.affiliation: Department of Surgery, University Medical Center, Utrecht, The Netherlands; Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Besselink
authors.affiliation: Department of Gastroenterology, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Robin
authors.initials: R
authors.lastname: Timmer
authors.affiliation: Department of Surgery, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands.
authors.forename: Camiel
authors.initials: C
authors.lastname: Rosman
authors.affiliation: Department of Surgery, University Medical Center St Radboud, Nijmegen, The Netherlands.
authors.forename: Harry
authors.initials: H
authors.lastname: van Goor
authors.affiliation: Department of Surgery, University Medical Center, Utrecht, The Netherlands.
authors.forename: Rian M
authors.initials: RM
authors.lastname: Nijmeijer
authors.affiliation: Department of Surgery, University Medical Center, Utrecht, The Netherlands; Department of Surgery, University Medical Center St Radboud, Nijmegen, The Netherlands.
authors.forename: Hein
authors.initials: H
authors.lastname: Gooszen
authors.affiliation: Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Henri G D
authors.initials: HG
authors.lastname: Leuvenink
authors.affiliation: Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Rutger J
authors.initials: RJ
authors.lastname: Ploeg
authors.affiliation: Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: v.b.nieuwenhuijs@isala.nl.
authors.forename: Vincent B
authors.initials: VB
authors.lastname: Nieuwenhuijs
mesh_terms: D000208:Acute Disease; D000368:Aged; D042702:Angiopoietin-2 / Q000097:blood*; D001424:Bacterial Infections / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D003661:Decision Support Techniques; D004311:Double-Blind Method; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D010195:Pancreatitis / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D019283:Pancreatitis, Acute Necrotizing / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control; D011237:Predictive Value of Tests; D019936:Probiotics / Q000627:therapeutic use; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index
chemical_list: D042702:Angiopoietin-2; D015415:Biomarkers
keywords: Ang-2; Angiopoietin-2; IL; IQR; LBP; MOF; NPV; PPV; PROPATRIA study; ROC; SAP; interleukin; interquartile range; lipopolysaccharide-binding protein; multiorgan failure; negative predictive value; positive predictive value; probiotics vs placebo in patients with predicted severe acute pancreatitis study; receiver-operator curves; severe acute pancreatitis