Serum levels of apolipoprotein A-I and high-density lipoprotein can predict organ failure in acute pancreatitis
Peng et al. Critical Care
Serum levels of apolipoprotein A-I and high-density lipoprotein can predict organ failure in acute pancreatitis
Yun-Shing Peng 1 4
Yung-Chang Chen 1 2
Ya-Chung Tian 1 2
Chih-Wei Yang 1 2
Jau-Min Lien 0 1
Ji-Tseng Fang 1 2
Cheng-Shyong Wu 1 8
Chien-Fu Hung 1 7
Tsan-Long Hwang 1 6
Ying-Huang Tsai 1 5
Mel S Lee 1 9
Ming-Hung Tsai 0 1 3
0 Division of Digestive Therapeutic Endoscopy, Chang Gung Memorial Hospital , 199, Tung-Hwa North Road, Taipei , Taiwan
1 Chang Gung University, College of Medicine , 259, Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan , Taiwan
2 Division of Critical Care Nephrology, Chang Gung Memorial Hospital , 199, Tung-Hwa North Road, Taipei , Taiwan
3 Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chang Gung University , 199, Tung-Hwa North Road, Taipei 105 , Taiwan
4 Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital , 6 , West Section , Chia-Pu Road, Chia-Yi , Taiwan
5 Division of Thoracic and Critical Care Medicine, Chang Gung Memorial Hospital , 6 , West Section , Chia-Pu Road, Chia-Yi , Taiwan
6 Division of General Surgery, Chang Gung Memorial Hospital , 199, Tung-Hwa North Road, Taipei , Taiwan
7 Department of Radiology, Chang Gung Memorial Hospital , 199, Tung-Hwa North Road, Taipei , Taiwan
8 Division of Gastroenterology, Chang Gung Memorial Hospital , 6 , West Section , Chia-Pu Road, Chia-Yi , Taiwan
9 Department of Surgery, Chang Gung Memorial Hospital , 6 , West Section , Chia-Pu Road, Chia-Yi , Taiwan
Introduction: 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- 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.
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Introduction
Acute pancreatitis represents an acute inflammatory
disorder with variable severity ranging from mild, self-limited
disease to a severe inflammatory cascade associated with
multiple-organ failure. Despite the improvements in
critical care, severe acute pancreatitis (SAP) is still associated
with a high mortality rate [1]. Although the incidence of
organ failure in the early phase (within the first week)
varies among different studies [2-6], persistent organ failure
(OF) has been shown to be the major determinant of
clinical outcomes [6,7]. These observations have led to
modified definitions of SAP, which recognize the
importance of persistent OF and introduce a new
subclassification of moderately severe pancreatitis based on
the presence of transient OF [8,9].
It is important to stratify the severity of acute
pancreatitis. First, early identification of patients with potential
SAP may facilitate timely referral to specialists. Second,
for specialists, severity-stratification of those patients
makes triage and comparison between different studies
possible. However, when organ failure is present in the
early phase, it may be difficult to determine the final
degree of severity because it is unknown whether the
patient will prove to have persistent or transient OF.
It has been shown that the concentrations of total
cholesterol and lipoproteins decrease in the early stages
of critical illness [10-12]. Indeed, the pattern of early
rapid decline is found primarily in the high-density
lipoprotein (HDL) [12]. Moreover, the protein composition
of HDL is markedly alte (...truncated)