Applicability Of Platelet Indices And Fibrin Related Markers In The Assessment Of The Severity Of Acute Pancreatitis

Part I Mean Platelet Volume: A Useful Marker of Acute Pancreatitis with Persistent Organ FailureAim: The aim of this prospective study is to investigate serum MPV levels in acute pancreatitis(AP)patients and assess whether MPV would be useful in predicting disease severity in AP compare with white blood cell(WBC),lactate dehydrogenase(LDH)and C-reactive protein(CRP)Methods: We included 117 consecutive patients with AP and 34 consecutive patients with colorectal polyps before endoscopic treatment as control group.There have no statistically significant difference in age and sex between the AP patients and the control group.Full blood counts,serum amylase,liver function test,platelet indices(MPV),coagulation parameters,LDH and CRP were measured on day 1,2,3 and 7 after admission.Modified Glasgow Prognostic Score(m GPS)were used as to evaluate the disease severity in AP and 2012 revised Atlanta criteria were used as to evaluate persistent organ failure(POF)in AP.Receiver operating characteristic(ROC)curves were used to compare the sensitivity,specificity,PPV and NPV of MPV,WBC,LDH and CRP in predicting AP severity.Results: There was significantly reduced MPV levels in AP patients compared with control group on day1(P=0.000),day2(P=0.029)and day3(P=0.001)after admission.And MPV values on day1 after admission were lower than on day2(P=0.012),day3(P=0.000)and day7((P=0.002)after admission in all AP patients.According to m GPS,78 patients(66.7%)were classified as mild and 39 patients(33.3%)were classified as severe AP.There have no statistically significant difference in mean MPV levels in mild and severity AP according to m GPS(P=0.424).According to 2012 revised Atlanta criteria,there were 98 patients(83.8%)without POF(non-SAP group)and 19 patients(16.2%)with POF(SAP group).There have statistically significant decreased in mean MPV levels in SAP compare with non-SAP group on day1 after admission according to 2012 revised Atlanta criteria(P=0.002).Overall accuracy of MPV in predicting SAP according to 2012 revised Atlanta criteria,at a cut off value of 6.65 fl with a sensitivity of 91.8%(AUC=0.716),was superior to traditional WBC(AUC=0.700),LDH(AUC=0.697)on day1 after admission.Conclusion: MPV can be as a useful,non-invasive biomarkers with no additional cost to distinguish AP with POF from that without POF on day1 of hospital admission.Part II The clinical utility of fibrin-related biomarkers in human acute pancreatitisAim: Our aim is to investigate whether four fibrin-related markers(FRMs): Fibrin Monomer(FM),D-Dimer(D-D);fibrinogen and fibrin degradation products(FDP)and fibrinogen(FIB)reflect the extent of coagulation activation in vivo and to assess the predictive value of the four FRMs in determining persistent organ failure(POF)and pancreatic necrosis(PN)Methods: 152 Patients of AP and 34 consecutive patients with colorectal polyps before endoscopic treatment were included in this prospective observational study.The final outcomes were disease severity assessed by presence of POF and PN.Four FRMs and antithrombin-III(AT-III)levels were assessed on day 1,2,3 and 7 of admission.Receiver operating characteristic(ROC)curves were used to compare the sensitivity,specificity,PPV and NPV of FM,D-D,FDP and AT-III in predicting POF and PN compare with regular biochemical marker CRP and LDH.Results: Of the 152 patients included,32 patients with POF and 44 patients with PN.FM(P=0.003),D-dimer(P=0.000),FDP(P=0.000)and fibrinogen(P=0.000)were significantly higher in AP patients than control group on all days.There have no significally different in serum FM level between AP with POF and AP without POF on the first week after admission.Patients with PN shows higher FM than without PN on day 1(P=0.043),day 2(P=0.008),day 3(P=0.001)and day 7(P=0.002)after admission.D-D was higher in patients with POF than that without on day1(P=0.001),day 2(P=0.004),day 3(P=0.000)and day 7(P=0.002).Patients with PN shows higher D-D on day 1(P=0.023),day 2(P=0.045),day 3(P=0.000)and day 7(P=0.000)after admission.FDP was higher in patients with POF than that without on day1(P=0.000),day2(P=0.000),day3(P=0.000)and day7(P=0.000);Patients with PN shows higher FDP on day2(P=0.021),day3(P=0.000)and day 7(P=0.000)after admission.FIB was higher in AP patient than control group on the first week after admission,but there have no significantly different between AP with POF and without,and there have no significantly difference between AP with PN and that without.ROC analysis revealed D-D(AUC=0.693)and FDP(AUC=0.711)superior than CRP(AUC=0.615)and LDH(AUC=0.672)in predicted POF on day1 of hospital admission,and D-D(AUC=0.832)and FDP(AUC=0.814)superior than LDH(AUC=0.639)and AT-III(AUC=0.635)in predicted PN on day3 of hospital admission.Conclusion: Plasma FRMs in AP patients were increased significantly on the first week after admission.FDP and D-D were correlation with disease severity of AP and can be considered as a potentially useful tool for the early diagnosis of AP with POF and PN.