Prediction of the severity of acute pancreatitis on admission by carboxypeptidase-B activation peptide: A systematic review and meta-analysis.
OBJECTIVE
The assessment of acute pancreatitis severity on admission currently remains a challenge to clinicians. A single, rapid biochemical marker would be preferable to clinical and radiological scoring systems. The aim of this study was to undertake a meta-analysis on the value of carboxypeptidase-B activation peptide (CAPAP) in predicting severity of acute pancreatitis on admission.


METHODS
Major databases and trial registries were searched to identify all relevant studies from January 1998 to March 2015. Pooled sensitivity, specificity and the diagnostic odds ratios (DOR) with 95% confidence interval (CI) were calculated for each study and were compared to other biomarkers, if included, within the same study. Summary receiver-operating curves (ROC) were conducted and the area under the curve (AUC) was evaluated.


RESULTS
In total, six studies were included. At the time of admission, the AUC of serum CAPAP for predicting severity of acute pancreatitis was 0.86 with pooled sensitivity, specificity and DOR of 0.90, 0.70 and 19.08, respectively. When serum CAPAP was compared with urinary CAPAP, the AUC, pooled sensitivity, specificity and DOR were 0.69 vs 0.88, 0.90 vs 0.81, 0.68 vs. 0.77 and 17.96 vs. 18.58, respectively. Similarly, the AUC, pooled sensitivity, specificity and DOR of serum CAPAP vs maximal serum C-reactive protein within the first 3 days of admission were found to be 0.97 vs. 0.82, 0.92 vs. 0.88, 0.81 vs 0.68 and 37.90 vs. 18.80, respectively.


CONCLUSIONS
Both serum and urinary CAPAP have the potential to act as a stratification marker on admission in predicting severity of acute pancreatitis.
Sichuan Provincial Pancreatitis Center, Department of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Lihui
L
Deng
Sichuan Provincial Pancreatitis Center, Department of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Lei
L
Wang
Sichuan Provincial Pancreatitis Center, Department of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Fengjiao
F
Yong
Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Junjie
J
Xiong
Sichuan Provincial Pancreatitis Center, Department of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Tao
T
Jin
NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool L69 3GA, United Kingdom.
Daniel
D
De La Iglesia-Garcia
NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool L69 3GA, United Kingdom.
Shameena
S
Bharucha
NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool L69 3GA, United Kingdom.
Kiran
K
Altaf
NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool L69 3GA, United Kingdom. Electronic address: dr_wei_huang@163.com.
Wei
W
Huang
Sichuan Provincial Pancreatitis Center, Department of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Qing
Q
Xia
D015415:Biomarkers / Q000097:blood; D043424:Carboxypeptidase B / Q000097:blood*; D006801:Humans; D010195:Pancreatitis / Q000097:blood* / Q000175:diagnosis*; D010343:Patient Admission / Q000639:trends; D011237:Predictive Value of Tests; D012720:Severity of Illness Index
D015415:Biomarkers; D043424:Carboxypeptidase B
Acute pancreatitis; C-reactive protein; Carboxypeptidase-B activation peptide; Meta-analysis; Severity