Intestinal fatty acid binding protein as a marker of necrosis and severity in acute pancreatitis

Abstract

Introduction About 20 % of acute pancreatitis(AP) cases are severe with considerable mortality rate of 10-25 %. Despite several scoring systems and markers used, none are offering high sensitivity and specificity in identifying patients with a high risk of severe acute pancreatitis. Aims & Methods This study aimed to evaluate intestinal fatty acid binding protein(i-FABP) as potential marker for severity assessment and prediction of AP. The study was designed as part of the Pancreas 2000 educational program. Patients with AP were prospectively included at 5 clinical centers the years 2010-2012. Local complications were confirmed by performing abdominal CT. Severity of AP was determined based on 1992 Atlanta criteria1 as data was collected before the revision of Atlanta classification. Serum i-FABP levels at day 1 and 3 of AP were determined using ELISA. Mann-Whitney U-test, Chi-square, Multivariate logistic regression analysis and ROC curve tests were used for statistical analysis. Results In the cohort of 402 patients (253 men, 149 women), 65 patients had severe AP. Serum i-FABP levels at day 1 were significantly higher in patients with pancreatic necrosis (median – 698 pg/mL vs 342 pg/mL), in patients having systemic complications (median – 501.5 pg/mL vs 382.5 pg/mL), in patients treated invasively (median – 549.5 pg/mL vs 379.5 pg/mL) in patients treated in ICU (median – 578 pg/mL vs 372 pg/mL) in patients with severe AP (median – 638.5 pg/mL vs 353 pg/mL) and in deceased patients (1073 pg/mL vs 382.5 pg/mL). i-FABP levels at day 1 yielded an AUC of 0.732 with an optimal cut-off value of 537 pg/mL in discriminating patients with pancreatic necrosis (sensitivity - 73.3%, specificity of 70.2%, negative predictive value (NPV) – 96.6%, positive predictive value (PPV) – 18.6%). Furthermore, i-FABP levels at day 1 of AP provided AUC of 0.669 with an optimal cut-off value of 465.5pg/mL in predicting [...].