Admission Serum Heparin-Binding Protein Levels Within 24h Is Associated With The Severity Of Acute Pancreatitis

Background and aims:Acute pancreatitis(AP)is one of the common critical diseases in clinical,especially severe acute pancreatitis(SAP).It has the characteristics of rapid progression,poor clinical outcomes,early and late complications and high mortality.Persistent organ failure(POF)caused by systemic inflammatory response syndrome(SIRS)is the main cause of early death of SAP patients.Early and accurate identification of POF is very important for SAP patients,because studies have shown that timely and effective treatment can improve the prognosis of SAP patients and reduce their mortality.Heparin binding protein(HBP)is a trypsin-like serine protein present in polymorphonuclear neutrophil secreted granules.It has many biological functions including bactericidal,inflammatory,enhancing vascular permeability,chemotaxis,and improving cell penetration.The concentration of HBP in the early stages of many acute inflammations and critical illnesses can be significantly increased.This study aims to explore the relationship between early serum HBP levels and SAP.Methods:1.Design: A prospective,observational cohort study2.Patients: We selected AP patients and healthy volunteers who met the inclusion criteria in the First Affiliated Hospital of Nanchang University from January 2019 to October 2019.3.Sample processing and measurement: Collecting venous blood samples that meet the criteria for admission and place them in a centrifuge and centrifuge at 3000 r/ mins for 15 minutes.The upper serum to be stored in a-80°C refrigerator.According to the instructions of Novus' s enzyme linked immunosorbent assay(ELISA)kit,determine the serum HBP concentration in the sample4.Statistical analysis: Calculate the HBP value of the sample by Origin software(R>0.99).SPSS 25 software is used for statistical analysis of data.Continuous variables are expressed as median or interquartile rang and analyzed by Student's t-test or the Mann-Whitney U test.Categorical variables are expressed as proportions analyzed by Chi-square test or Fisher Exact test.Receiver operating characteristic(ROC)curve was used to evaluate the value of serum HBP levels in predicting POF.A P value of <0.05 was considered statistically significant.Results:1.Baseline characteristics: This study included of 14 healthy volunteers and 66 AP patients,in which includes 28 mild acute pancreatitis(MAP),18 moderately severe acute pancreatitis(MSAP)and 20 SAP.There were no significant differences in age,sex,etiology,and body mass index between the four groups.2.Detection of serum HBP levels in different groups: The concentrations of serum HBP in healthy volunteers,MAP,MSAP,and SAP groups were respectively3.9(3.4-5)ng/ml,5.2(3.9-6.8)ng/ml,5.9(4.6-7.7)ng/ml and 11(8.0-13.8)ng/ml.The severity of AP patients is correlated with their serum HBP concentrations,especially in SAP patients.The serum HBP level of SAP patients is significantly higher than that of non-SAP patients(11(8.0-13.8)ng/ml vs 5.4(4.-7.3)ng/ml,P<0.01).3.Evaluate the value of HBP in predicting SAP: At the cutoff HBP?7ng/ml,the sensitivity,specificity and area under curve(AUC)of predicting SAP were 90%,74% and 0.82,respectively.The sensitivity reached the highest value.At the cutoff bedside index for severity in AP(BISAP)?3,the sensitivity,specificity and AUC of the predicting SAP were 75%,93.5%,and 0.84,respectively.The specificity and AUC values reached the highest.The predictive value of acute physiology and chronic health evaluation ? scores(APACHE ? scores)and serum urea nitrogen were lower than HBP and BISAP scores.4.Comparison of outcomes in different HBP levels groups: Patients with high HBP level(Serum HBP?7ng/ml)have significantly poor outcomes than lower HBP level(Serum HBP<7ng/ml)patients,including hospital-mortality(0% vs 20%,P<0.01),infected pancreatic necrosis(2.8% vs 30%,P <0.01),acute necroticcollection(14% vs 53%,P<0.01),extra-pancreatic infectious(25% vs 57%,P <0.01),hospital stay(3.9(3.4-5)vs 5.5(4-9)days,P <0.01),and hospital stay in intensive care unit(0(0-0)vs 5.5(0-14)days,P <0.01).Conclusions:1.The increased concentration of HBP within 24 hours of admission was associated with the severity of AP.2.Admission high HBP levels within 24 hours maybe be a useful indicator for predicting SAP.3.High HBP levels within 24 hours of admission is associated with poor prognosis in AP.