A team from Magdeburg and Aachen, Germany, investigated the potential to predict severe disease and lethality in acute pancreatitis, by using plasma soluble thrombomodulin (sTM) and C-reactive protein (CRP) levels.
A total of 73 patients with acute pancreatitis were enrolled in the prospective study.
According to the Atlanta criteria, pancreatitis was classified as mild in 23 patients and as severe in 50 patients.
Blood was collected on days 1, 3, 5, 7, 10, 14, 21, and 28 after the onset of pain, and was analyzed for sTM and CRP.
Most of the admissions occurred between days 3 and 10 of acute pancreatitis.
During this period, sTM levels at a cutoff of 75 ng/ml on day 3 and 71 ng/ml on day 10 were predictive of a lethal outcome.
Both of these cutoff levels had a sensitivity of 100%, a specificity of 77%, and a negative predictive value of 100%.
However, the positive predictive value was slightly lower when using the sTM level on day 3 (38% vs 41%).
| sTM levels predict acute pancreatitis patients who are at most risk of dying.
With sTM levels, it was not possible to differentiate patients with mild pancreatitis from those with severe pancreatitis.
In contrast, CRP levels at a cutoff of 113 mg/l on day 3 differentiated severe from mild courses with a diagnostic sensitivity of 84%, a specificity of 60%, a positive predictive value of 78%, and a negative predictive value of 69%.
CRP levels at a cutoff of 122 mg/L on day 10 differentiated mild from severe courses (nonsurvivors) with a diagnostic sensitivity of 72%, a specificity of 72%, a positive predictive value of 86%, and a negative predictive value of 53%.
In contrast, differentiation of mild forms of acute pancreatitis from severe pancreatitis (survivors) on day 10 was not possible.
Dr Rene Mantke, of the Otto-von-Guericke-University of Magdeburg, said on behalf of fellow authors, "CRP is a valuable marker of disease severity in acute pancreatitis, especially in the first period of pancreatitis.
"On the other hand, sTM identifies early those patients with the most severe courses and a high risk of dying.
"Determination of sTM, in addition to CRP, offers the opportunity of identifying early those patients who require intensive care most urgently."
"Of course, further investigations of sTM in acute pancreatitis are indicated to confirm our results," it was concluded.