title: The clinical value of adipokines in predicting the severity and outcome of acute pancreatitis.
abstract: BACKGROUND
  Recent data shows that patients with severe acute pancreatic might benefit from early intensive therapy, enteral nutrition and timely transfer to specialized centers. The early prophylactic use of antibiotics in AP remains controversial. The role and need for new markers in stratification of acute pancreatitis is also uncertain. This study aims to evaluate the prognostic usefulness of adipokines in prediction of the severity and outcome of acute pancreatitis (AP).
  
  
  METHODS
  Prospective study was conducted in four clinical centers. The diagnosis and severity assessment of AP was established according to the revised 2012 Atlanta classification. Adipokines, IL-6 and CRP levels were measured at admission and on 3rd day of hospital stay and compared with the control group. The predictive accuracy of each marker was measured by area under the receiver operating curve.
  
  
  RESULTS
  Forty healthy controls and 102 patients were enrolled in to the study. Twenty seven (26.5 %) patients had mild, 55 (53.9 %) - moderate and 20 (19.6 %) - severe AP. Only resistin (cut-off value 13.7 ng/ml) and IL-6 (cut-off value 473.4 pg/ml) were reliable early markers of SAP. IL-6 with cut-off value of 157.0 pg/ml was a predictor of necrosis. The peripancreatic necrosis volume of 112.5 ml was a marker of SAP and 433.0 ml cut-off value could be used to predict the need of interventions.
  
  
  CONCLUSIONS
  The prognostic value of adipokines in AP is limited. Only admission resistin levels could serve as an early predictor for SAP. The Lithuanian Regional Ethics Committee approved the study protocol (permission No. L-12-02/1/2/3/4) and all the patients and the control group provided written informed consent.
authors.affiliation: Center of Abdominal Surgery, Faculty of Medicine, Vilnius University, Santariskiu 2, LT-08661, Vilnius, Lithuania. andrius.karpavicius@gmail.com.|Department of Abdominal Surgery, Clinic of Surgery, Vilnius City Clinical Hospital, Antakalnio 57, LT-10207, Vilnius, Lithuania. andrius.karpavicius@gmail.com.
authors.forename: Andrius
authors.identifier: http://orcid.org/0000-0002-0656-7943
authors.initials: A
authors.lastname: Karpavicius
authors.affiliation: Institute for Digestive System Research, Lithuanian University of Health Sciences, Eiveniu 2, LT-50009, Kaunas, Lithuania.|Department of Surgery, Lithuanian University of Health Sciences, Eiveniu 2, LT-50009, Kaunas, Lithuania.
authors.forename: Zilvinas
authors.initials: Z
authors.lastname: Dambrauskas
authors.affiliation: Department of Abdominal Surgery, Clinic of Surgery, Vilnius City Clinical Hospital, Antakalnio 57, LT-10207, Vilnius, Lithuania.|Department of Nursing and Fundamentals of Internal Medicine, Faculty of Medicine, Vilnius University, Antakalnio 57, LT-10207, Vilnius, Lithuania.
authors.forename: Audrius
authors.initials: A
authors.lastname: Gradauskas
authors.affiliation: Radiology and Nuclear medicine Center, Faculty of Medicine, Vilnius University, Santariskiu 2, LT-08661, Vilnius, Lithuania.
authors.forename: Arturas
authors.initials: A
authors.lastname: Samuilis
authors.affiliation: Department of Radiology, Lithuanian University of Health Sciences, Eiveniu 2, LT-50009, Kaunas, Lithuania.
authors.forename: Kristina
authors.initials: K
authors.lastname: Zviniene
authors.affiliation: Department of Gastroenterology, Lithuanian University of Health Sciences, Eiveniu 2, LT-50009, Kaunas, Lithuania.
authors.forename: Juozas
authors.initials: J
authors.lastname: Kupcinskas
authors.affiliation: Center of General Surgery, Faculty of Medicine, Vilnius University, Siltnamiu 29, LT-04130, Vilnius, Lithuania.
authors.forename: Gintautas
authors.initials: G
authors.lastname: Brimas
authors.affiliation: Center of General Surgery, Faculty of Medicine, Vilnius University, Siltnamiu 29, LT-04130, Vilnius, Lithuania.
authors.forename: Artur
authors.initials: A
authors.lastname: Meckovski
authors.affiliation: Center of Abdominal Surgery, Faculty of Medicine, Vilnius University, Santariskiu 2, LT-08661, Vilnius, Lithuania.
authors.forename: Audrius
authors.initials: A
authors.lastname: Sileikis
authors.affiliation: Center of Abdominal Surgery, Faculty of Medicine, Vilnius University, Santariskiu 2, LT-08661, Vilnius, Lithuania.
authors.forename: Kestutis
authors.initials: K
authors.lastname: Strupas
mesh_terms: D000208:Acute Disease; D054392:Adipokines / Q000097:blood*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D054409:Nicotinamide Phosphoribosyltransferase / Q000097:blood; D010195:Pancreatitis / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D011446:Prospective Studies; D052243:Resistin / Q000097:blood; D012720:Severity of Illness Index
chemical_list: D054392:Adipokines; D015415:Biomarkers; D015850:Interleukin-6; D052243:Resistin; D002097:C-Reactive Protein; D054409:Nicotinamide Phosphoribosyltransferase
keywords: Acute pancreatitis; Adipokines; Adiponectin; Leptin; Prediction; Prognosis; Resistin; Severity; Visfatin