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Role of Pancreatic Stone Protein as an Early Biomarker for Risk Stratification of Acute Pancreatitis

Abstract

Background

Early risk stratification of acute pancreatitis is crucial to improve clinical outcomes. The objective of this study was to evaluate the ability of pancreatic stone protein (PSP) to predict acute pancreatitis severity and to compare it with the biomarkers and severity scores currently used for that purpose.

Patients and Methods

Prospective single-center observational study enrolling 268 adult patients with acute pancreatitis. Biomarkers including PSP were measured upon admission to the Emergency Department and severity scores as SOFA, PANC-3, and BISAP were computed. Patients were classified into mild-moderate (non-severe) and severe acute pancreatitis according to the Determinant-Based Classification Criteria. Area under the curve (AUC) and regression analysis were used to analyze the discrimination abilities and the association of biomarkers and scores with severity.

Results

Two hundred and thirty-five patients (87.7%) were classified as non-severe and 33 (12.3%) as severe acute pancreatitis. Median [IQR] PSP was increased in patients with severe acute pancreatitis (890 μg/L [559–1142] vs. 279 μg/L [141–496]; p < 0.001) and it was the best predictor (ROC AUC: 0.827). In multivariate analysis, PSP and urea were the only independent predictors for severe acute pancreatitis and a model combining them both (“biomarker model”) showed an AUC of 0.841 for prediction of severe acute pancreatitis, higher than the other severity scores.

Conclusions

PSP is a promising biomarker for predicting the severity of acute pancreatitis upon admission. A model combining PSP and urea might further constitute a potential tool for early risk stratification of this disease.

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Abbreviations

APACHE:

Acute Physiology and Chronic Health Evaluation

AUC:

Area under the curve

BISAP:

Bedside Index for Severity in Acute Pancreatitis

CBC:

Cell blood count

CRP:

C-reactive protein

DBC:

Determinant-Based Classification

ED:

Emergency Department

ICU:

Intensive Care Unit

PSP:

Pancreatic stone protein

ERCP:

Post-endoscopic retrograde cholangiopancreatography pancreatitis

SOFA:

Sequential organ failure assessment

ROC:

Receiver operating characteristic

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Funding

Abionic SA supported the study by providing reagents and other material for measurement of PSP. Abionic SA participates neither in the study design nor in the analysis or interpretation of the results.

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Authors and Affiliations

Authors

Contributions

CRR and LGGR designed the study and analyzed the data. LGGR wrote the manuscript. SMS, JP, YAQ, and MDAO critically reviewed the manuscript. CRR and RB measured PSP levels in blood samples. SMS and VAS contributed to the enrollment of patients and clinical data collection. All authors approved the final version of the manuscript and its submission. All authors are responsible for the entire content of the manuscript.

Corresponding author

Correspondence to Luis García de Guadiana-Romualdo.

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Conflict of interest

The authors have no conflict of interest.

Ethics approval

The study was approved by the Hospital Ethics Committee (E. O. 2018-51) and was carried out by following the Declaration of Helsinki of the World Medical Association.

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Rodríguez Rojas, C., García de Guadiana-Romualdo, L., Morán Sánchez, S. et al. Role of Pancreatic Stone Protein as an Early Biomarker for Risk Stratification of Acute Pancreatitis. Dig Dis Sci 67, 3275–3283 (2022). https://doi.org/10.1007/s10620-021-07152-6

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Keywords

  • Acute pancreatitis
  • Severity
  • Prognosis
  • Pancreatic stone protein