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Xu TT, Chen SB. The value of immature granulocyte percentage united with D-Dimer in the evaluation of severe pancreatitis and its prognosis. Clinics (Sao Paulo) 2024; 79:100446. [PMID: 39003926 DOI: 10.1016/j.clinsp.2024.100446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 06/23/2024] [Accepted: 06/27/2024] [Indexed: 07/16/2024] Open
Abstract
OBJECTIVE The study aimed at analyzing the serum expression of Immature Granulocyte percentage (IG %) and D-Dimer (D-D) in patients with severe pancreatitis and exploring their clinical diagnostic value. METHODS Eighty-four cases with severe pancreatitis received in Shengjing Hospital, China Medical University from July 2020 to July 2023 were regarded as the study group and conducted for retrospective analysis. They were divided into a survival group (n = 62) and a death group (n = 22) based on the prognosis. Another 80 patients diagnosed with mild and moderate pancreatitis were selected as the control group. Serum IG % and D-D levels of all subjects were analyzed and the value of IG % and D-D in the evaluation of severe pancreatitis and its prognosis was conducted by Receiver Operating Characteristic (ROC) curve. RESULTS The IG % and D-D levels in the study group were markedly higher than the control group (p < 0.05). The IG % and D-D level in the death group were observably higher than the survival group (p < 0.05). The Area Under the Curve (AUC) of IG % and D-D combined assessment for severe pancreatitis was 0.963, and the sensitivity and specificity were 98.75 %, 82.14 %, respectively. The AUC of IG % and D-D combined assessment for prognosis of severe pancreatitis was 0.814 with a sensitivity of 79.03 % and a specificity of 77.27 %. The efficiency of joint evaluation of the two indicators is superior to the individual evaluation. CONCLUSION Serum IG % and D-D are highly expressed in patients with severe pancreatitis, which has important clinical value for the evaluation of severe pancreatitis and its prognosis.
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Affiliation(s)
- Tian-Tian Xu
- Department of Critical Care Medicine, Shengjing Hospital, China Medical University, Shenyang City, Liaoning Province, China
| | - Si-Bing Chen
- Department of Rehabilitation Medicine, Shengjing Hospital, China Medical University, Shenyang City, Liaoning Province, China.
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Pavalean MC, Ionita-Radu F, Jinga M, Costache RS, Balaban DV, Patrasescu M, Chirvase M, Maniu I, Gaman L, Bucurica S. Ferritin and Ferritin-to-Hemoglobin Ratio as Promising Prognostic Biomarkers of Severity in Acute Pancreatitis-A Cohort Study. Biomedicines 2024; 12:106. [PMID: 38255211 PMCID: PMC10813292 DOI: 10.3390/biomedicines12010106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Acute pancreatitis is an inflammation of the pancreas with variable outcomes depending on its severity. Multiple systems of prediction have been proposed, each with variable specificity and sensitivity and with uneven clinical use. Ferritin is a versatile protein associated with various acute and chronic conditions. AIMS In our study, we aimed to assess the association of serum ferritin and the ferritin-to-hemoglobin ratio (FHR) with the severity of acute pancreatitis. METHODS A retrospective study was conducted in our hospital from January 2020 to September 2022 and included 116 patients with acute pancreatitis (graded according to the revised Atlanta classification). Serum ferritin and FHR were determined next to established laboratory parameters in the first 24 h following admission (hematological parameters, amylase, lipase, C-reactive protein, D-dimers, lactate dehydrogenase). We performed a receiver operating characteristic curve analysis for potential predictors. Also, we made correlations and conducted univariate and multivariate analyses for all potential severity biomarkers. RESULTS The median values of serum ferritin and FHR differed significantly between patients with severe acute pancreatitis and mild cases (serum ferritin: 352.40 vs. 197.35 ng/mL, p = 0.011; FHR: 23.73 vs. 13.74, p = 0.002) and between patients with organ failure and those without organ failure (serum ferritin: 613.45 vs. 279.65 ng/mL, p = 0.000; FHR: 48.12 vs. 18.64, p = 0.000). The medians of the serum ferritin and FHR levels were significantly higher in non-survivors compared with survivors (serum ferritin: 717.71 vs. 305.67 ng/mL, p = 0.013; FHR: 52.73 vs. 19.58, p = 0.016). Serum ferritin and FHR were good predictors for organ failure and mortality, next to D-dimers and procalcitonin (AUC > 0.753 for organ failure and AUC > 0.794 for mortality). In univariate regression analysis, serum ferritin and FHR were independent variables for moderate-severe forms of acute pancreatitis. Still, adjusting the multivariate analysis, only FHR remained a significant predictor. The cut-offs for serum ferritin and FHR for predicting organ failure were 437.81 ng/mL (sensitivity, 71%; specificity, 75%) and 45.63 (sensitivity, 61%; specificity, 88%), and those for mortality during hospitalization were 516 ng/mL (sensitivity, 83%; specificity, 74%) and 51.58 (sensitivity, 66%; specificity, 86%). CONCLUSIONS Serum ferritin and the ferritin-to-hemoglobin ratio stood out in this study as valuable and accessible predictors of disease severity in the early assessment of acute pancreatitis, next to established severity serum markers (CRP, fibrinogen, D-dimers).
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Affiliation(s)
- Mihaela Cristina Pavalean
- Department of Cellular, Molecular Biology and Histology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Florentina Ionita-Radu
- Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.I.-R.); (M.J.); (R.S.C.); (D.V.B.); (M.P.)
- Department of Gastroenterology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania;
| | - Mariana Jinga
- Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.I.-R.); (M.J.); (R.S.C.); (D.V.B.); (M.P.)
- Department of Gastroenterology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania;
| | - Raluca Simona Costache
- Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.I.-R.); (M.J.); (R.S.C.); (D.V.B.); (M.P.)
- Department of Gastroenterology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania;
| | - Daniel Vasile Balaban
- Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.I.-R.); (M.J.); (R.S.C.); (D.V.B.); (M.P.)
- Department of Gastroenterology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania;
| | - Mihaita Patrasescu
- Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.I.-R.); (M.J.); (R.S.C.); (D.V.B.); (M.P.)
- Department of Gastroenterology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania;
| | - Mirela Chirvase
- Department of Gastroenterology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania;
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ionela Maniu
- Research Team, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania;
- Department of Mathematics and Informatics, Faculty of Sciences, Lucian Blaga University Sibiu, 550012 Sibiu, Romania
| | - Laura Gaman
- Department of Biochemistry, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Sandica Bucurica
- Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.I.-R.); (M.J.); (R.S.C.); (D.V.B.); (M.P.)
- Department of Gastroenterology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania;
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Venegas-Tamayo AR, Peña-Veites OM, Hernández-González MA, Barrientos-Alvarado C. Decreased HDL-C Levels as a Predictor of Organ Failure in Acute Pancreatitis in the Emergency Department. Life (Basel) 2023; 13:1602. [PMID: 37511976 PMCID: PMC10381343 DOI: 10.3390/life13071602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/07/2023] [Accepted: 07/09/2023] [Indexed: 07/30/2023] Open
Abstract
High-density lipoprotein cholesterol (HDL-C) is reported as a biomarker of systemic inflammation and multi-organ failure (MOF), which has been rarely investigated in acute pancreatitis (AP), a frequent condition in the emergency department (ED). The objective was to study the predictive capacity of the decrease in HDL-C to the progression of MOF in AP in the ED; analyzing 114 patients with AP for one year in a longitudinal and prospective study, AP severity was obtained by the Atlanta classification, in relation to modified Marshall and Bedside Index for Severity in Acute Pancreatitis (BISAP) scores, and clinical and laboratory parameters in a 48 h hospital stay. The area under the receiver operating characteristic (ROC) curve was used to estimate the validity of the predictor and define optimal cut-off points. It was found that AP was classified as severe in 24.5%, mainly for biliary etiology (78.9%) and female sex (73.6%). As a biomarker, HDL-C decreased from 31.6 to 29.5 mg/dL in a 48 h stay (p < 0.001), correlating negatively with the increase in severity index > 2 and the modified Marshall (p < 0.032) and BISAP (p < 0.009) scores, finding an area under the ROC curve with a predictive capacity of 0.756 (95% CI, 0.614-0.898; p < 0.004) and a cut-off point of 28.5 mg/dL (sensitivity: 79%, specificity: 78%), demonstrating that the decrease in HDL-C levels serves as a useful indicator with a predictive capacity for MOF in mild to severe AP, during a 48 h hospital stay in the ED.
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Affiliation(s)
- Ana Rocío Venegas-Tamayo
- High Specialty Medical Unit No. 1, National Medical Center of Bajío, Mexican Social Security Institute, Leon 37320, Guanajuato, Mexico
| | - Olga Mariel Peña-Veites
- High Specialty Medical Unit No. 1, National Medical Center of Bajío, Mexican Social Security Institute, Leon 37320, Guanajuato, Mexico
| | - Martha Alicia Hernández-González
- High Specialty Medical Unit No. 1, National Medical Center of Bajío, Mexican Social Security Institute, Leon 37320, Guanajuato, Mexico
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Li B, Wu W, Liu A, Feng L, Li B, Mei Y, Tan L, Zhang C, Tian Y. Establishment and Validation of a Nomogram Prediction Model for the Severe Acute Pancreatitis. J Inflamm Res 2023; 16:2831-2843. [PMID: 37449283 PMCID: PMC10337691 DOI: 10.2147/jir.s416411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023] Open
Abstract
Background Severe acute pancreatitis (SAP) can progress to lung and kidney dysfunction, and blood clotting within 48 hours of its onset, and is associated with a high mortality rate. The aim of this study was to establish a reliable diagnostic prediction model for the early stage of severe pancreatitis. Methods The clinical data of patients diagnosed with acute pancreatitis from October 2017 to June 2022 at the Shangluo Central Hospital were collected. The risk factors were screened by least absolute shrinkage and selection operator (LASSO) regression analysis. A novel nomogram model was then established by multivariable logistic regression analysis. Results The data of 436 patients with acute pancreatitis, 45 (10.3%) patients had progressed to SAP. Through univariate and LASSO regression analyses, the neutrophils (P <0.001), albumin (P < 0.001), blood glucose (P < 0.001), serum calcium (P < 0.001), serum creatinine (P < 0.001), blood urea nitrogen (P < 0.001) and procalcitonin (P = 0.005) were identified as independent predictive factors for SAP. The nomogram built on the basis of these factors predicted SAP with sensitivity of 0.733, specificity of 0.9, positive predictive value of 0.458 and negative predictive value of 0.967. Furthermore, the concordance index of the nomogram reached 0.889 (95% CI, 0.837-0.941), and the area under the curve (AUC) in receiver operating characteristic curve (ROC) analysis was significantly higher than that of the APACHEII and ABISAP scoring systems. The established model was validated by plotting the clinical decision curve analysis (DCA) and clinical impact curve (CIC). Conclusion We established a nomogram to predict the progression of early acute pancreatitis to SAP with high discrimination and accuracy.
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Affiliation(s)
- Bo Li
- Department of Pancreatic Surgery, Shangluo Center Hospital, Shangluo, Shaanxi, 726000, People’s Republic of China
| | - Weiqing Wu
- Department of Pancreatic Surgery, Shangluo Center Hospital, Shangluo, Shaanxi, 726000, People’s Republic of China
| | - Aijun Liu
- Department of Pancreatic Surgery, Shangluo Center Hospital, Shangluo, Shaanxi, 726000, People’s Republic of China
| | - Lifeng Feng
- Department of Pancreatic Surgery, Shangluo Center Hospital, Shangluo, Shaanxi, 726000, People’s Republic of China
| | - Bin Li
- Department of Pancreatic Surgery, Shangluo Center Hospital, Shangluo, Shaanxi, 726000, People’s Republic of China
| | - Yong Mei
- Department of Pancreatic Surgery, Shangluo Center Hospital, Shangluo, Shaanxi, 726000, People’s Republic of China
| | - Li Tan
- Department of Pancreatic Surgery, Shangluo Center Hospital, Shangluo, Shaanxi, 726000, People’s Republic of China
| | - Chaoyang Zhang
- Department of Ultrasound Medicine, Shangluo Center Hospital, Shangluo, Shaanxi, 726000, People’s Republic of China
| | - Yangtao Tian
- Department of Pancreatic Surgery, Shangluo Center Hospital, Shangluo, Shaanxi, 726000, People’s Republic of China
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Kong D, Lei Z, Wang Z, Yu M, Li J, Chai W, Zhao X. A novel HCP (heparin-binding protein-C reactive protein-procalcitonin) inflammatory composite model can predict severe acute pancreatitis. Sci Rep 2023; 13:9440. [PMID: 37296194 PMCID: PMC10256784 DOI: 10.1038/s41598-023-36552-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023] Open
Abstract
Severe acute pancreatitis (SAP) presents with an aggressive clinical presentation and high lethality rate. Early prediction of the severity of acute pancreatitis will help physicians to further precise treatment and improve intervention. This study aims to construct a composite model that can predict SAP using inflammatory markers. 212 patients with acute pancreatitis enrolled from January 2018 to June 2020 were included in this study, basic parameters at admission and 24 h after hospitalization, and laboratory results such as inflammatory markers were collected. Pearson's test was used to analyze the correlation between heparin-binding protein (HBP), procalcitonin (PCT), and C-reactive protein (CRP). Risk factors affecting SAP were analyzed using multivariate logistic regression, inflammatory marker models were constructed, and subject operating curves were used to verify the discrimination of individual as well as inflammatory marker models and to find the optimal cut-off value based on the maximum Youden index. In the SAP group, the plasma levels of HBP, CRP, and PCT were 139.1 ± 74.8 ng/mL, 190.7 ± 106.3 mg/L and 46.3 ± 22.3 ng/mL, and 25.3 ± 16.0 ng/mL, 145.4 ± 67.9 mg/L and 27.9 ± 22.4 ng/mL in non-SAP patients, with a statistically significant difference between the two groups (P < 0.001), The Pearson correlation analysis showed a positive correlation between the three values of HBP, CRP, and PCT. The results of the multivariate logistic regression analysis showed that HBP (OR = 1.070 [1.044-1.098], P < 0.001), CRP (OR = 1.010 [1.004-1.016], P = 0.001), and PCT (OR = 1.030[1.007-1.053], P < 0.001) were risk factors for SAP, and the area under the curve of the HBP-CRP-PCT model was 0.963 (0.936-0.990). The HCP model, consisting of HBP, CRP, and PCT; is well differentiated and easy to use and can predict the risk of SAP in advance.
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Affiliation(s)
- Deshuai Kong
- Department of Hepatobiliary and Pancreatic Surgery, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Zhang Lei
- Department of Hepatobiliary and Pancreatic Surgery, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Zhenyong Wang
- Department of Hepatobiliary and Pancreatic Surgery, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Meng Yu
- Department of Hepatobiliary and Pancreatic Surgery, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Jinchao Li
- Department of Hepatobiliary and Pancreatic Surgery, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Wei Chai
- Department of Hepatobiliary and Pancreatic Surgery, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Xiulei Zhao
- Department of Hepatobiliary and Pancreatic Surgery, Cangzhou Central Hospital, Cangzhou, Hebei, China.
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Rubino F, Alvarez-Breckenridge C, Akdemir K, Conley AP, Bishop AJ, Wang WL, Lazar AJ, Rhines LD, DeMonte F, Raza SM. Prognostic molecular biomarkers in chordomas: A systematic review and identification of clinically usable biomarker panels. Front Oncol 2022; 12:997506. [PMID: 36248987 PMCID: PMC9557284 DOI: 10.3389/fonc.2022.997506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction and objectiveDespite the improvements in management and treatment of chordomas over time, the risk of disease recurrence remains high. Consequently, there is a push to develop effective systemic therapeutics for newly diagnosed and recurrent disease. In order to tailor treatment for individual chordoma patients and develop effective surveillance strategies, suitable clinical biomarkers need to be identified. The objective of this study was to systematically review all prognostic biomarkers for chordomas reported to date in order to classify them according to localization, study design and statistical analysis.MethodsUsing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically reviewed published studies reporting biomarkers that correlated with clinical outcomes. We included time-to-event studies that evaluated biomarkers in skull base or spine chordomas. To be included in our review, the study must have analyzed the outcomes with univariate and/or multivariate methods (log-rank test or a Cox-regression model).ResultsWe included 68 studies, of which only 5 were prospective studies. Overall, 103 biomarkers were analyzed in 3183 patients. According to FDA classification, 85 were molecular biomarkers (82.5%) mainly located in nucleus and cytoplasm (48% and 27%, respectively). Thirty-four studies analyzed biomarkers with Cox-regression model. Within these studies, 32 biomarkers (31%) and 22 biomarkers (21%) were independent prognostic factors for PFS and OS, respectively.ConclusionOur analysis identified a list of 13 biomarkers correlating with tumor control rates and survival. The future point will be gathering all these results to guide the clinical validation for a chordoma biomarker panel. Our identified biomarkers have strengths and weaknesses according to FDA’s guidelines, some are affordable, have a low-invasive collection method and can be easily measured in any health care setting (RDW and D-dimer), but others molecular biomarkers need specialized assay techniques (microRNAs, PD-1 pathway markers, CDKs and somatic chromosome deletions were more chordoma-specific). A focused list of biomarkers that correlate with local recurrence, metastatic spread and survival might be a cornerstone to determine the need of adjuvant therapies.
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Affiliation(s)
- Franco Rubino
- Department of Neurosurgery, Division of surgery, The University of Texas MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | - Christopher Alvarez-Breckenridge
- Department of Neurosurgery, Division of surgery, The University of Texas MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | - Kadir Akdemir
- Department of Neurosurgery, Division of surgery, The University of Texas MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | - Anthony P. Conley
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | - Andrew J. Bishop
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | - Wei-Lien Wang
- Department of Pathology, Division of Pathology-Lab Medicine Division, The University of Texas MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | - Alexander J. Lazar
- Department of Pathology, Division of Pathology-Lab Medicine Division, The University of Texas MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | - Laurence D. Rhines
- Department of Neurosurgery, Division of surgery, The University of Texas MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | - Franco DeMonte
- Department of Neurosurgery, Division of surgery, The University of Texas MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | - Shaan M. Raza
- Department of Neurosurgery, Division of surgery, The University of Texas MD Anderson Cancer Center, University of Texas, Houston, TX, United States
- *Correspondence: Shaan M. Raza,
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