Most patients with acute pancreatitis (AP) experience mild, self-limiting disease with little or no need for hospital care. However, 20–25% of patients develop a more severe and potentially life-threatening condition with progressive systemic inflammatory response syndrome (SIRS) and multiorgan failure, resulting in high morbidity and mortality rates. Predicting disease severity at an early stage is important, as immediate supportive care has been demonstrated to reduce the incidence of SIRS and organ failure, improving patient outcome. Several studies have demonstrated elevated levels of heparin-binding protein (HBP) in patients with sepsis and septic shock, and HBP is believed to play a part in endothelial dysfunction leading to vascular leakage. As HBP levels increase prior to other known biomarkers, HBP has emerged as a promising early predictor of severe sepsis with organ dysfunction. Patients admitted to Skåne University Hospital in Malmö between 2010 and 2013 fulfilling the criteria for AP were identified in the emergency department and prospectively enrolled in this study. The primary outcome was measured levels of HBP upon hospital admission in patients with confirmed AP. Correlations among HBP concentrations, disease severity and fluid balance were considered secondary endpoints. The correlation between HBP levels and fluid balance were analysed using Pearson correlation, and the ability of HBP to predict moderately severe/severe AP was assessed using a receiver operating characteristic (ROC) curve. The overall median HBP level in this study was 529 (307–898) ng/ml. There were no significant group differences in HBP levels based on AP severity. Fluid balance differed significantly between patients with mild versus moderately severe and severe pancreatitis, but we found no correlation between HBP concentration and fluid balance. HBP levels are dramatically increased in patients with AP, and these levels far exceed those previously reported in other conditions. In this study, we did not observe any significant correlation between HBP levels and disease severity or the need for intravenous fluid. Additional studies on HBP are needed to further explore the role of HBP in the pathogenesis of AP and its possible clinical implications.

中文翻译：

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急性胰腺炎肝素结合蛋白显着升高

大多数急性胰腺炎 (AP) 患者会出现轻度、自限性疾病，几乎不需要住院治疗。然而，20-25% 的患者会出现更严重且可能危及生命的疾病，伴有进行性全身炎症反应综合征 (SIRS) 和多器官衰竭，导致高发病率和死亡率。在早期预测疾病的严重程度很重要，因为已经证明立即支持治疗可以降低 SIRS 和器官衰竭的发生率，改善患者的预后。几项研究表明，脓毒症和感染性休克患者的肝素结合蛋白 (HBP) 水平升高，据信 HBP 与导致血管渗漏的内皮功能障碍有关。随着 HBP 水平先于其他已知生物标志物升高，HBP 已成为严重败血症伴器官功能障碍的有希望的早期预测指标。2010 年至 2013 年间入住马尔默斯科讷大学医院且符合 AP 标准的患者在急诊科确定，并前瞻性地纳入本研究。主要结果是确诊的 AP 患者入院时测量的 HBP 水平。HBP 浓度、疾病严重程度和体液平衡之间的相关性被认为是次要终点。使用 Pearson 相关分析 HBP 水平与体液平衡之间的相关性，使用受试者工作特征 (ROC) 曲线评估 HBP 预测中重度/重度 AP 的能力。本研究中的总体 HBP 中位数水平为 529 (307–898) ng/ml。基于 AP 严重程度的 HBP 水平没有显着的组间差异。轻度、中度和重度胰腺炎患者的体液平衡存在显着差异，但我们发现 HBP 浓度与体液平衡之间没有相关性。AP 患者的 HBP 水平显着升高，并且这些水平远远超过先前在其他情况下报道的水平。在这项研究中，我们没有观察到 HBP 水平与疾病严重程度或静脉输液需求之间的任何显着相关性。需要进一步研究 HBP 以进一步探讨 HBP 在 AP 发病机制中的作用及其可能的临床意义。但我们发现 HBP 浓度与体液平衡之间没有相关性。AP 患者的 HBP 水平显着升高，并且这些水平远远超过先前在其他情况下报道的水平。在这项研究中，我们没有观察到 HBP 水平与疾病严重程度或静脉输液需求之间的任何显着相关性。需要进一步研究 HBP 以进一步探讨 HBP 在 AP 发病机制中的作用及其可能的临床意义。但我们发现 HBP 浓度与体液平衡之间没有相关性。AP 患者的 HBP 水平显着升高，并且这些水平远远超过先前在其他情况下报道的水平。在这项研究中，我们没有观察到 HBP 水平与疾病严重程度或静脉输液需求之间的任何显着相关性。需要进一步研究 HBP 以进一步探讨 HBP 在 AP 发病机制中的作用及其可能的临床意义。