title: Circulating nucleosomes as predictive markers of severe acute pancreatitis.
abstract: BACKGROUND
  The components of nucleosomes, which contain DNA and histones, are released into the circulation from damaged cells and can promote inflammation. We studied whether the on-admission levels of circulating nucleosomes predict the development of severe acute pancreatitis (AP), in particular among the patients who present without clinical signs of organ dysfunction.
  
  
  METHODS
  This is a prospective study of 74 AP patients admitted to Helsinki University Hospital from 2003 to 2007. Twenty-three patients had mild, 27 moderately severe, and 24 severe AP as defined by the revised Atlanta criteria. 14/24 severe AP patients had no sign of organ dysfunction on admission (modified marshall score <2). Blood samples were obtained on admission and the plasma levels of nucleosomes were measured using enzyme-linked immunosorbent assay.
  
  
  RESULTS
  The on-admission levels of nucleosomes were significantly higher in severe AP than in mild or moderately severe AP (p < 0.001 for all), higher in non-survivors (n = 8) than in survivors (p = 0.019), and correlated with the on-admission levels of C-reactive protein (p < 0.001) and creatinine (p < 0.001). Among the AP patients who presented without organ dysfunction, the on-admission nucleosome level was an independent predictor of severe AP (p = 0.038, gender-adjusted forward-stepping logistic regression).
  
  
  CONCLUSIONS
  Circulating nucleosome levels may be helpful in identifying, on admission to hospital, the AP patients who present without clinical signs of organ dysfunction, and, yet, are bound to develop organ dysfunction during hospitalization.
authors.affiliation: Department of Surgery, Helsinki University Hospital, P.O. Box 340, 00029 HUS Helsinki, Finland.
authors.forename: Anne K
authors.initials: AK
authors.lastname: Penttilä
authors.affiliation: Neuroscience Center, University of Helsinki, P.O. Box 56, 00014 Helsinki, Finland.|Department of Biosciences, University of Helsinki, P.O. Box 65, 00014 Helsinki, Finland.
authors.forename: Ari
authors.initials: A
authors.lastname: Rouhiainen
authors.affiliation: Department of Surgery, Helsinki University Hospital, P.O. Box 340, 00029 HUS Helsinki, Finland.
authors.forename: Leena
authors.initials: L
authors.lastname: Kylänpää
authors.affiliation: Department of Surgery, Helsinki University Hospital, P.O. Box 340, 00029 HUS Helsinki, Finland.
authors.forename: Harri
authors.initials: H
authors.lastname: Mustonen
authors.affiliation: Department of Surgery, Helsinki University Hospital, P.O. Box 340, 00029 HUS Helsinki, Finland.|Institute of Clinical Medicine, University of Helsinki, P.O. Box 340, 00029 HUS Helsinki, Finland.
authors.forename: Pauli
authors.initials: P
authors.lastname: Puolakkainen
authors.affiliation: Neuroscience Center, University of Helsinki, P.O. Box 56, 00014 Helsinki, Finland.
authors.forename: Heikki
authors.initials: H
authors.lastname: Rauvala
authors.affiliation: Department of Bacteriology and Immunology, University of Helsinki, The Haartman Institute, P.O. Box 21, 00014 Helsinki, Finland.
authors.forename: Heikki
authors.initials: H
authors.lastname: Repo
keywords: Biomarkers; Cellular damage; Nucleosomes; Organ dysfunction; Pancreatitis