title: Serum levels of apolipoprotein A-I and high-density lipoprotein can predict organ failure in acute pancreatitis.
abstract: BACKGROUND
  Predicting severity of pancreatitis is an important goal. Clinicians are still searching for novel and simple biomarkers that can better predict persistent organ failure (OF). Lipoproteins, especially high-density lipoprotein (HDL), and apolipoprotein A-I (APO A-I), have been shown to have anti-inflammation effects in various clinical settings. Severe acute pancreatitis (SAP) is associated with hypo-lipoproteinemia. We studied whether the concentrations of HDL and APO A-I can predict persistent OF in patients with predicted SAP admitted to the ICU.
  
  
  METHODS
  In 66 patients with predicted SAP, we prospectively evaluated the relationship between lipid levels, inflammatory cytokines and clinical outcomes, including persistent OF and hospital mortality. Blood samples were obtained within 24 hours of admission to the ICU.
  
  
  RESULTS
  HDL and APO A-I levels were inversely correlated with various disease severity scores. Patients with persistent OF had lower levels of HDL and APO A-I, while those with transient OF had lower levels of interleukin-6, tumor necrosis factor-α and lower rates of hospital mortality. Meanwhile, hospital non-survivors had lower concentrations of HDL, and APO A-I compared to the survivors. By using the area under the receiver operating characteristic (AUROC) curve, both HDL and APO A-I demonstrated an excellent discriminative power for predicting persistent OF among all patients (AUROC 0.912 and 0.898 respectively) and among those with OF (AUROC 0.904 and 0.895 respectively). Pair-wise comparison of AUROC showed that both HDL and APO A-I had better discriminative power than C-reactive protein to predict persistent OF.
  
  
  CONCLUSIONS
  Serum levels of HDL and APO A-I at admission to the ICU are inversely correlated with disease severity in patients with predicted SAP and can predict persistent OF in this clinical setting.
authors: Yun-Shing
authors: YS
authors: Peng
authors: Yung-Chang
authors: YC
authors: Chen
authors: Ya-Chung
authors: YC
authors: Tian
authors: Chih-Wei
authors: CW
authors: Yang
authors: Jau-Min
authors: JM
authors: Lien
authors: Ji-Tseng
authors: JT
authors: Fang
authors: Cheng-Shyong
authors: CS
authors: Wu
authors: Chien-Fu
authors: CF
authors: Hung
authors: Tsan-Long
authors: TL
authors: Hwang
authors: Ying-Huang
authors: YH
authors: Tsai
authors: Mel S
authors: MS
authors: Lee
authors: Ming-Hung
authors: MH
authors: Tsai
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D016632:Apolipoprotein A-I / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008075:Lipoproteins, HDL / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood* / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018805:Sepsis / Q000401:mortality; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D016632:Apolipoprotein A-I; D015415:Biomarkers; D015850:Interleukin-6; D008075:Lipoproteins, HDL; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein