METHODS: 84 subjects (47 males, 37 females) with AP were divided into the subgroups according to body mass index (BMI), disease severity score (mild AP vs. severe AP) and computer tomography severity index score (CTSI A vs. CTSI B vs. CTSI C). All laboratory examinations were determined on day 1 and day 4 after admission. Adipokines were analyzed using the ELISA kit methods.
RESULTS: No significant variance was found in adipokine levels between subjects with mild and severe AP, but C-reactive protein (CRP) and interleukin 6 (IL-6) were significantly elevated in patients with severe AP on day 4 (CRP medians: 209.8 mg/L vs. 51.2 mg/L, p < 0.000; IL-6 medians: 79.5 ng/L vs. 25.9 ng/L, p < 0.01). FGF 21 medians were distinctly higher on day 1 in all observed subgroups compared to day 4 (mild AP: 669.9 ng/L vs. 261.7 ng/L; severe AP: 619.4 ng/L vs. 468.0 ng/L; CTSI A: 631.4 ng/L vs. 246.2 ng/L; CTSI B: 2226.3 ng/L vs. 693.1 ng/L; CTSI C: 572.6 ng/L vs. 310.8 ng/L). Similarly, this phenomenon was found for A-FABP and IL-6 as well. A-FABP and FGF 21 levels decreased during the first four days together, but independently of the IL-6 decline, regardless of AP severity.
CONCLUSIONS: Elevated levels of CRP and IL-6 in subjects with severe form of AP on day 4 indicate a diagnostic utility of both parameters in the disease severity prediction. Increased FGF 21 at admission compared to day 4 suggests its potential role as an immediate response gene during pancreatic injury. The dynamics of FGF 21 and A-FABP levels probably reflect the improvement of clinical condition in the early stage of AP.