Plasma cytokines can help to identify the development of severe acute pancreatitis on admission

Severe acute pancreatitis (AP) is associated with high morbidity and mortality. Early severity stratification remains a challenging issue to overcome to improve outcomes. We aim to find novel plasma cytokines for the early identification of severe AP according to the revised Atlanta criteria. In this prospective observational study, 30 cytokines, screened semiquantitatively with a human multicytokine array, were submitted to quantitative determination using either microparticle-based multiplex immunoassays analyzed on a Luminex 100 platform or enzyme-linked immunosorbent assay kits. The cytokine profiles of patients and the discriminative value of cytokines for severe AP were analyzed. Plasma samples of 70 patients with AP (20 mild, 30 moderately severe, and 20 severe) were selected in this study if they were admitted within 48hours of the onset of symptoms. Plasma from healthy volunteers was collected as the healthy control. Growth differentiation factor-15 (GDF-15) and pentraxin 3 (PTX3) on admission were independent prognostic markers for the development of severe AP and had higher discriminative powers than conventional markers (GDF-15 vs hematocrit, P=.003; GDF-15 vs C-reactive protein, P=.037; GDF-15 vs creatinine, P=.048; GDF-15 vs Acute Physiology and Chronic Health Evaluation II, P=.007; PTX3 vs hematocrit, P=.006; PTX3 vs C-reactive protein, P=.047; PTX3 vs Acute Physiology and Chronic Health Evaluation II, P=.011; PTX3 vs Bedside Index for Severity in Acute Pancreatitis, P=.048). Plasma GDF-15 and PTX3 can help to identify the development of severe AP on admission. Future work should validate their accuracy in a larger, multicenter patient cohort.Secreted, ROC curve = receiver-operating characteristic curve, SIRS = systemic inflammatory response syndrome, SOFA = Sequential Organ Failure Assessment, ST2 = suppression of tumorigenicity 2.