Introduction
Acute pancreatitis (AP) is an acute disease of the pancreas with several serum indicators of the disease severity (C-reactive protein (CRP), procalcitonin (PCT)), but none of them are accurate. YKL-40 (chitinase-3-like-1 protein) is a glycoprotein that plays a mayor role in the inflammation and angiogenesis. Development of peripancreatic fluid collections (PFC) in the AP complicates the clinical course of the disease and often requires advanced endoscopic or surgical treatment. Early recognition of PFCs could lead to new therapeutic options and their improved management.
Aims & Methods
The aim of our study was to compare the diagnostic yield of YKL-40 and interleukin 6 (IL-6) versus routine laboratory markers in prediction of PFCs in AP. This prospective study recruited 57 patients (23 male, 34 female) with AP at the University Hospital Center Sestre Milosrdnice, Zagreb, from June 2020 until December 2021. After obtaining informed consent, patients had blood drawn for routine laboratory studies (including CRP and PCT) with additional 7 milliliters of blood for determining serum concentrations of YKL-40 and IL-6 on admission and 48 hours after admission. Presence of PFCs was determined with a computer tomography scan carried out 72-96 hours after admission. Analysis were performed using enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristic curve was calculated, confidence intervals were obtained using bootstrap method with 1000 iterations, and areas under the curve (AUCs) were compared using Kruskal-Wallis, Dunn, and Mann-Whitney tests.
Results
The AUC values are presented in Table 1. Post-hoc Dunn test with Bonferroni correcton indicated that there is a statistical difference between all pairwise comparisons in AUC scores for PFC predicton of investigated biomarkers both on admission and 48 hours after admission (P <0.05). Both YKL-40 and IL-6 had an order of magnitude better AUC scores than CRP and PCT. At 48 hours after admission, CRP AUC scores improved drastically, reaching AUC scores comparable with YKL-40 and IL-6, with all of the biomarkers having AUC scores in range of moderately good predictors. IL-6 had the best AUC scores overall in both groups.
Table 1.
| On admission (AUC [95%CI]) | 48 hours after admission (AUC [95%CI])
| Mann-Whitney U between measurements P
|
CRP
| 0.55 [0.25-0.83] | 0.82 [0.61-1.0]
| <<0.05
|
PCT
| 0.57 [0.03-0.89]
| 0.61 [0.12-0.97]
| 0.06
|
YKL-40
| 0.70 [0.38-0.86]
| 0.81 [0.51- 0.97]
| <<0.05
|
IL-6
| 0.8 [0.6-0.96]
| 0.85 [0.63-1.0] | <<0.05 |
Kruskall wallis test P
| <<0.05
| <<0.05
|
|
Conclusion
Results demonstrated that IL-6 on admission and YKL-40 (alongside CRP) 48 hours after admission may be good early predictors for PFCs and the need for future invasive treatments, but due to small sample size and low study power further measurements are needed to confirm these preliminary results.
References
1. Arvanitakis M, Dumonceau JM, Albert J, et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy. 2018;50(5):524-546.
2. Lee DW, Cho CM. Predicting Severity of Acute Pancreatitis. Medicina (Kaunas). 2022;11;58(6):787.