Calcitonin precursors: early markers of gut barrier dysfunction in patients with acute pancreatitis.

Abstract

BACKGROUND:

Severe acute pancreatitis is associated with an early increase in intestinal permeability and endotoxemia. Endotoxin is a potent stimulator for the production and release of procalcitonin and its components (calcitonin precursors; [CTpr]). The aim of this study is to evaluate the role of plasma CTpr as an early marker for gut barrier dysfunction in patients with acute pancreatitis.

METHODS:

Intestinal permeability to macromolecules (polyethylene glycol 3350), serum endotoxin and antiendotoxin core antibodies, plasma CTpr, and serum C-reactive protein (CRP) were measured on admission in 60 patients with acute pancreatitis. Attacks were classified as mild (n = 48) or severe (n = 12) according to the Atlanta criteria.

RESULTS:

Compared with mild attacks of acute pancreatitis, severe attacks were significantly associated with an increase in intestinal permeability index (median: 0.02 vs. 0.006, P < 0.001), the frequency of endotoxemia (73% vs. 41%, P = 0.04), and the extent of depletion of serum IgM antiendotoxin antibodies (median: 43 MMU vs. 100 MMU, P = 0.004). Plasma CTpr levels were significantly elevated in patients with severe attacks compared with mild attacks on both the day of admission and on day 3 (median: 64 vs. 22 fmol/mL, P = 0.03; and 90 vs. 29 fmol/mL, P = 0.003 respectively). A positive and significant correlation was observed between the admission serum endotoxin and plasma CTpr levels on admission (r = 0.7, P < 0.0001) and on day 3 (r = 0.96, P < 0.0001), and between plasma CTpr on day 7 and the intestinal permeability index (r = 0.85, P = 0.0001). In contrast, only a weak positive correlation was observed between peak serum levels of CRP and plasma CTpr on admission (r = 0.3, P = 0.017) and on day 7 (r = 0.471, P = 0.049), as well as between CRP and each of the admission serum endotoxin (r = 0.3, P = 0.03) and the intestinal permeability index (r = 0.375, P = 0.007).

CONCLUSIONS:

In patients with acute pancreatitis, plasma concentrations of CTpr appear to reflect more closely the derangement in gut barrier function rather than the extent of systemic inflammation.

• Authors: B J Ammori, K L Becker, P Kite, R H Snider, E S Nylén, J C White, G R Barclay, M Larvin, M J McMahon
• Journal: Pancreas (Pancreas) Vol. 27 Issue 3 Pg. 239-43 (Oct 2003) ISSN: 1536-4828 [Electronic] United States
• PMID: 14508129 (Publication Type: Journal Article)

Chemical References

• Antibodies
• Biomarkers
• CALCA protein, human
• Endotoxins
• Protein Precursors
• Polyethylene Glycols
• Calcitonin
• C-Reactive Protein
• Calcitonin Gene-Related Peptide

Topics

• Acute Disease
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Antibodies (immunology)
• Biomarkers (blood)
• C-Reactive Protein (analysis)
• Calcitonin (blood)
• Calcitonin Gene-Related Peptide
• Endotoxemia (blood, complications, physiopathology)
• Endotoxins (blood, immunology)
• Female
• Humans
• Inflammation (blood, complications)
• Intestines (physiopathology)
• Male
• Middle Aged
• Pancreatitis (blood, complications, physiopathology)
• Permeability
• Polyethylene Glycols
• Prognosis
• Protein Precursors (blood)