title: The Interplay between Inflammation, Coagulation and Endothelial Injury in the Early Phase of Acute Pancreatitis: Clinical Implications.
abstract: Acute pancreatitis (AP) is an inflammatory disease with varied severity, ranging from mild local inflammation to severe systemic involvement resulting in substantial mortality. Early pathologic events in AP, both local and systemic, are associated with vascular derangements, including endothelial activation and injury, dysregulation of vasomotor tone, increased vascular permeability, increased leukocyte migration to tissues, and activation of coagulation. The purpose of the review was to summarize current evidence regarding the interplay between inflammation, coagulation and endothelial dysfunction in the early phase of AP. Practical aspects were emphasized: (1) we summarized available data on diagnostic usefulness of the markers of endothelial dysfunction and activated coagulation in early prediction of severe AP; (2) we reviewed in detail the results of experimental studies and clinical trials targeting coagulation-inflammation interactions in severe AP. Among laboratory tests, d-dimer and angiopoietin-2 measurements seem the most useful in early prediction of severe AP. Although most clinical trials evaluating anticoagulants in treatment of severe AP did not show benefits, they also did not show significantly increased bleeding risk. Promising results of human trials were published for low molecular weight heparin treatment. Several anticoagulants that proved beneficial in animal experiments are thus worth testing in patients.
authors.affiliation: Department of Medical Diagnostics, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland. paulina.dumnicka@uj.edu.pl.
authors.forename: Paulina
authors.initials: P
authors.lastname: Dumnicka
authors.affiliation: Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, 31-034 Kraków, Poland. dawid.maduzia@uj.edu.pl.
authors.forename: Dawid
authors.initials: D
authors.lastname: Maduzia
authors.affiliation: Department of Physiology, Jagiellonian University Medical College, Grzegórzecka 16, 31-531 Kraków, Poland. mpcerano@cyf-kr.edu.pl.
authors.forename: Piotr
authors.initials: P
authors.lastname: Ceranowicz
authors.affiliation: Department of Pharmacology, Jagiellonian University Medical College, Grzegórzecka 16, 31-531 Kraków, Poland. rafal.olszanecki@uj.edu.pl.
authors.forename: Rafał
authors.initials: R
authors.lastname: Olszanecki
authors.affiliation: Department of Medical Diagnostics, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland. ryszard.drozdz@uj.edu.pl.
authors.forename: Ryszard
authors.initials: R
authors.lastname: Drożdż
authors.affiliation: Department of Diagnostics, Chair of Clinical Biochemistry, Jagiellonian University Medical College, Kopernika 15A, 31-501 Kraków, Poland. mbkusnie@cyf-kr.edu.pl.
authors.forename: Beata
authors.initials: B
authors.lastname: Kuśnierz-Cabala
mesh_terms: D000208:Acute Disease; D000818:Animals; D000925:Anticoagulants / Q000627:therapeutic use; D015415:Biomarkers; D001777:Blood Coagulation; D002450:Cell Communication; D016207:Cytokines / Q000378:metabolism; D004727:Endothelium / Q000378:metabolism* / Q000473:pathology*; D006487:Hemostasis; D006801:Humans; D007249:Inflammation / Q000378:metabolism* / Q000473:pathology; D018836:Inflammation Mediators / Q000378:metabolism; D008833:Microcirculation; D010195:Pancreatitis / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D011379:Prognosis; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D016207:Cytokines; D018836:Inflammation Mediators
keywords: acute pancreatitis; coagulation; endothelial injury; inflammation; laboratory markers