Cardiac indicator CK-MB might be a predictive marker for severity and organ failure development of acute pancreatitis

Abstract

Background: The prediction of severe acute pancreatitis (SAP) is the key to providing timely and targeted intensive care for acute pancreatitis (AP). The heart is one of multiple organs involved in the early stage of SAP, but the predictive ability of cardiac dysfunction for SAP remains elusive. We sought to determine if the serum levels of three cardiac indicators (CI) including N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac troponin I (cTNI), and creatine kinase myocardial band (CK-MB) at admission could predict the occurrence of SAP and the development of related organ failure (OF).Methods: A retrospective, single-center cohort study was conducted on the files of patients presenting to the emergency intensive care unit and medical ward of a regional hospital in Shanghai. Patients diagnosed as having AP and who met the 2012 Atlanta guideline were admitted within 48 hours after disease onset.Results: Of the 670 AP patients screened, 238 were enrolled into the study and divided into mild acute pancreatitis (MAP) (n=59), moderate severe acute pancreatitis (MSAP) (n=123), and SAP (n=56) groups.No significant difference was found in baseline age, gender, duration from disease onset to admission, comorbidity, or substance abuse. As the levels of three CIs were significantly higher in the SAP group than in the MAP and MSAP groups, the enrolled patients were regrouped into non-SAP and SAP groups for predictive evaluation. Multivariate analysis and nomogram modelling showed that CK-MB, but not cTNI or NT-proBNP predicted the occurrence of SAP [area under curve (AUC) =0.805, confidence interval (CI): 0.794-0.905]. Specifically, 89 patients with OF (Modified Marshall score ≥2) upon admission were selected and CK-MB was shown to predict (AUC =0.805, CI: 0.794-0.905) persistent OF (n=48, duration of OF >48 hours) compared to transient organ failure (TOF) (n=41, duration of OF <48 hours).Conclusions: CIs including NT-proBNP, cTNI, and CK-MB were elevated in the early stage of AP. CK-MB might be used as an efficient predictive biomarker for SAP occurrence and OF development at admission.

Leukocyte cell population data from the blood cell analyzer as a predictive marker for severity of acute pancreatitis

“…Some studies proved that age increases with AP severity, 56 , 57 while other cohort studies reported no significant difference in age between non‐SAP and SAP, 58 , 59 , 60 which is also consistent with our current study and previous cohort study of 238 AP patients. 61 Furthermore, central obesity, hypertriglyceridemia (HTG), hypertension (HT), and diabetes mellitus (DM), a set of comorbidities termed metabolic syndrome (MetS), 62 were also reported ambiguous correlation with SAP. 59 , 63 Explanation for these paradoxical findings can be varied.…”

Elevation of creatine kinase in acute pancreatitis: A case report

“…Their study also revealed the cardiac dysfunction can happen in the early stage of acute pancreatitis and is usually demonstrated by echocardiography (cardiac regional wall motion abnormalities and impaired diastolic function) and electrocardiography (T‐wave flattering and ST‐segment depression). 2 Although our patient had some nonspecific ST‐T change in ECG, echocardiography showed no systolic or diastolic dysfunction and no regional wall motion abnormality. Randeva et al 5 showed that the CK‐MB was less than 5% of total CK activity, and in myocardial involvement increased over time that peaks 24 h later, while in extracardiac elevation of MB isoenzyme a plateau pattern may be more common.…”

“…Therefore, myocardial injury unlikely caused the elevation of the CK/CK‐MB. On the contrary, Zao et al 2 . reported elevated CK activity that may rarely occur in patients with acute pancreatitis peaked 1 day after admission.…”

“… 13 All mentioned explanations are related to cardiac involvement and elevated cardiac biomarkers and symptoms compatible with myocardial injury. Zao et al 2 reported that the level of CK‐MB showed a predictive ability of severe acute pancreatitis occurrence while cardiac troponin and pro‐BNP did not. Mainly CK‐MB was considered an independent determinant of organ failure in acute pancreatitis, which may lead to severe acute pancreatitis.…”

“…Elevated CK may be seen in a severe form of acute pancreatitis with the evidence of hypotension and myocardial involvement. 2 Recently, we observed a case of elevated serum CK/CK‐MB in a patient with non‐severe acute pancreatitis, which case is now presented.…”