Plasma ADAMTS13 activity parallels the APACHE II score, reflecting an early prognostic indicator for patients with severe acute pancreatitis
| Autor: | Masanori Matsumoto, Akira Mitoro, Masayoshi Sawai, Hiromichi Ishizashi, Masao Fujimoto, Motoyuki Yoshida, Seiji Kato, Tomomi Matsuyama, Masahito Uemura, Kenji Nishino, Tatsuhiro Tsujimoto, Michiaki Hata, Hitoshi Yoshiji, Yoshihiro Fujimura, Masatoshi Ishikawa, Junichi Yamao, Kazuo Okuchi, Yasuyuki Urizono, Hiroshi Fukui, Chie Morioka |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
medicine.medical_specialty
Pancreatic disease Multiple Organ Failure ADAMTS13 Protein Severity of Illness Index Gastroenterology Von Willebrand factor Predictive Value of Tests hemic and lymphatic diseases Internal medicine von Willebrand Factor Blood plasma Severity of illness Humans Medicine Platelet APACHE biology business.industry Prognosis medicine.disease ADAMTS13 ADAM Proteins Endocrinology Pancreatitis Acute Disease biology.protein Acute pancreatitis business |
| Zdroj: | Scandinavian Journal of Gastroenterology. 43:1387-1396 |
| ISSN: | 1502-7708 0036-5521 |
| DOI: | 10.1080/00365520802179933 |
| Popis: | Severe acute pancreatitis (SAP) frequently progresses to pancreatitis-associated multiorgan failure (MOF) with high mortality. Decreased plasma ADAMTS13 activity (ADAMTS13:AC) results in the accumulation of unusually large von Willebrand factor multimers (UL-VWFM) and the formation of platelet thrombi, ultimately leading to MOF. The purpose of the study was to investigate the potential role of ADAMTS13:AC in the severity of SAP.Plasma ADAMTS13:AC and its related parameters were sequentially determined in 13 SAP patients. ADAMTS13:AC was determined by the chromogenic act-ELISA.Within 1 or 2 days after admission, ADAMTS13:AC was lower in SAP patients (mean 28%) than in healthy controls (99%), and gradually recovered in the 11 survivors but further decreased in the 2 non-survivors. Patients with higher sepsis-related organ failure assessment (SOFA) scores showed lower ADAMTS13:AC than those without these scores. The inhibitor against ADAMTS13 was undetectable. On day 1, von Willebrand factor antigen (VWF:Ag) was higher (402%, p0.001) in SAP patients than in controls (100%). VWF:Ag gradually decreased in the survivors, except in the 3 patients needing a necrosectomy, but remained high in the non-survivors. ADAMTS13:AC was inversely correlated with the APACHE II score (r=-0.750, p0.005), and increased plasma concentrations of interleukin 6 (IL-6) and IL-8 at admission. UL-VWFM-positive patients had lower ADAMTS13:AC and decreased serum calcium concentrations, but higher VWF:Ag and IL-8 concentrations than UL-VWFM-negative patients.Plasma ADAMTS13:AC was closely related to the APACHE II score. This intimate relationship may serve as an early prognostic indicator for SAP patients. The imbalance between decreased ADAMTS13:AC and increased UL-VWFM could contribute to SAP pathogenesis through enhanced thrombogenesis. |
| Databáze: | OpenAIRE |
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