Angiopoietin-2 Is an Early Predictor for Acute Gastrointestinal Injury and Intestinal Barrier Dysfunction in Patients with Acute Pancreatitis

Huang, Qing; Wu, Zhe; Chi, Cheng; Wu, Chunbo; Su, Lin; Zhang, Yuanyuan; Zhu, Jihong; Liu, Yulan

doi:10.1007/s10620-020-06138-0

Cited by 17 publications

(22 citation statements)

References 17 publications

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“…Whitcomb et al 17 Whitcomb et al 17 Espinosa et al 34 Buddingh et al 31 Zhang et al 32 Dumnicka et al 35 Huang et al 33 1 distribution, indicating that the heterogeneity of this meta-analysis could not be explained by a threshold effect. The I 2 and P-values of the pooled sensitivity and specificity were 72.67% (P < 0.01) and 91.65% (P < 0.01), respectively, indicating significant heterogeneity among the included studies (Figure 2).…”

Section: Quadas Itemmentioning

confidence: 80%

“…33 The patients in Huang et al. 33 were all within 24 hours of onset, and blood collection for Ang-2 measurement was also within 24 hours of admission. The AUC for predicting OF was 0.980, with a cutoff value of 11.76 ng/mL, and sensitivity and specificity were 100% and 95.2%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, six original reports consisting of seven case-control studies were included in our meta-analysis. 17,[31][32][33][34][35] Of these, four studies were carried out in the United States and Europe and two studies were carried out in Asia. The included studies were published from 2010 to 2020.…”

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

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Accuracy of angiopoietin-2 for predicting organ failure in patients with acute pancreatitis: a systematic review and meta-analysis

Lv¹,

Yao²,

Liu

et al. 2021

J Int Med Res

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Objective Our aim was to assess the accuracy of angiopoietin-2 (Ang-2) as a prognostic marker for acute pancreatitis (AP) with organ failure (OF). Methods We undertook a systematic search of the PubMed, Cochrane Library, Embase, Chinese Journals Full-text, Wanfang, China Biology Medicine disc, and Weipu databases to identify eligible cohort studies on the predictive value of Ang-2 for AP with OF. The main outcome measures were sensitivity and specificity. The effects were pooled using a bivariate mixed-effects model. Results Six articles with seven case-control studies (n = 650) were included. Pooled sensitivity, specificity, and positive and negative likelihood ratios with 95% confidence intervals (CI) for AP with OF were 0.93 (95%CI: 0.75–0.99), 0.85 (95%CI: 0.75–0.92), 6.40 (95%CI: 3.36–12.19), and 0.08 (95%CI: 0.02–0.36), respectively. The area under the summary receiver operating characteristic curve was 0.95 (95%CI: 0.92–0.96), and the diagnostic odds ratio was 83.18 (95%CI: 11.50–623.17). Subgroup analysis showed that admission time of AP onset (< or ≥24 hours) was a source of overall heterogeneity. Sensitivity analysis supported this finding. Conclusion Ang-2 had high diagnostic accuracy for AP with OF; the best prediction of Ang-2 may be 24 to 72 hours after onset of AP.

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Section: Quadas Itemmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

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Accuracy of angiopoietin-2 for predicting organ failure in patients with acute pancreatitis: a systematic review and meta-analysis

Lv¹,

Yao²,

Liu

et al. 2021

J Int Med Res

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“…Angiopoietin-2 is a paracrine peptide that destabilizes endothelial cells and increases vascular permeability via inhibition of the Tie2 pathway. Angiopoietin-2 levels are increased in patients with SAP and predict SAP with high accuracy [14,29]. Nonetheless, a therapeutic agent targeting microvascular dysfunction has not yet been tested in AP; such mechanistic studies are underway for sepsis models [30].…”

Section: Microvasculature Dysfunctionmentioning

confidence: 99%

“…Early prediction of SAP continues to be limited by lack of accurate prognostic tools [13]. Measurement of serum cytokines such as IL-6, IL-8, angiopoietin-2, and resistin appears to predict SAP more accurately than laboratory tests and clinical scoring systems, but head-to-head comparison studies are lacking and cytokine measurements are not available in clinical practice [14][15][16]. Recently there have been several advancements in defining the timing and type of endoscopic therapy in AP patients with infected walled-off pancreatic necrosis and the role of endoscopic biliary decompression in biliary AP [17••].…”

Section: Introductionmentioning

confidence: 99%

Management of Severe Acute Pancreatitis

Lee

Papachristou

2020

Curr Treat Options Gastro

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Purpose of review There have been significant advancements in different aspects of management of severe acute pancreatitis (SAP). Our review of the most recent literature focuses on severity prediction, fluid resuscitation, analgesic administration, nutrition, and endoscopic intervention for SAP and its extra-pancreatic complications. Recent findings Recent studies on serum cytokines for the prediction of SAP have shown superior prognostic performance when compared with conventional laboratory tests and clinical scoring systems. In patients with established SAP and vascular leak syndrome, intravenous fluids should be administered with caution to prevent intra-abdominal hypertension and volume overload. Endoscopic retrograde cholangiopancreatography improves outcomes only in AP patients with suspected cholangitis. Early enteral tubefeeding does not appear to be superior to on-demand oral feeding. Abdominal compartment syndrome is a highly lethal complication of SAP that requires percutaneous drainage or decompressive laparotomy. Endoscopic transmural drainage followed by necrosectomy (i.e., "step-up approach") is the treatment strategy of choice in patients with symptomatic or infected walled-off pancreatic necrosis. Summary SAP is a complex clinical syndrome associated with a high mortality rate. Early prediction of SAP remains challenging due to the limited accuracy of the available prediction tools. Early fluid resuscitation, organ support, enteral nutrition, and prevention of/or prompt recognition of abdominal compartment syndrome remain cornerstones of its management. A step-up, minimally invasive drainage/debridement is the preferred approach for patients with infected pancreatic necrosis.

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Inhibition of angiotensin II type 1 receptor reduces oxidative stress damage to the intestinal barrier in severe acute pancreatitis

Gao

Jiang

Wang

et al. 2023

The Kaohsiung J of Med Scie

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Intestinal barrier injury is a common complication of severe acute pancreatitis (SAP), which is often accompanied by intestinal mucosal barrier injury and results in serious consequences. However, the exact mechanism remains unclear. We aimed to investigate whether angiotensin II type 1 receptor (AT1)‐mediated oxidative stress is involved in SAP intestinal barrier injury and assessed the effects of inhibiting this pathway. The SAP model was established by retrograde bile duct injection of sodium taurocholate (5%). The rats were divided into three groups: the control group (SO), the SAP group (SAP), and the azilsartan intervention group (SAP + AZL). Serum amylase, lipase, and other indexes were measured to evaluate SAP severity in each group. Histopathological changes in the pancreas and intestine were evaluated by HE staining. The oxidative stress of intestinal epithelial cells was detected by superoxide dismutase and glutathione. We also detected the expression and distribution of intestinal barrier‐related proteins. The results showed that the serum indexes, the severity of tissue damage, and the level of oxidative stress in the SAP + AZL group were significantly lower than in the SAP group. Our study provided hitherto undocumented evidence of AT1 expression in the intestinal mucosa, confirming that AT1‐mediated oxidative stress is involved in SAP intestinal mucosal injury, and inhibiting this pathway could effectively reduce intestinal mucosal oxidative stress injury, providing a new and effective target for the treatment of SAP intestinal barrier injury.

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Angiopoietin-2 Is an Early Predictor for Acute Gastrointestinal Injury and Intestinal Barrier Dysfunction in Patients with Acute Pancreatitis

Cited by 17 publications

References 17 publications

Accuracy of angiopoietin-2 for predicting organ failure in patients with acute pancreatitis: a systematic review and meta-analysis

Accuracy of angiopoietin-2 for predicting organ failure in patients with acute pancreatitis: a systematic review and meta-analysis

Management of Severe Acute Pancreatitis

Inhibition of angiotensin II type 1 receptor reduces oxidative stress damage to the intestinal barrier in severe acute pancreatitis

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