Serum amyloid A is a better early predictor of severity than C-reactive protein in acute pancreatitis

Abstract

Background: Serum amyloid A (SAA) is an early and sensitive marker of the extent of tissue trauma and in¯ammation. The aim of this study was to compare the early prognostic accuracy of SAA with that of serum C-reactive protein (CRP) in acute pancreatitis.Methods: In a prospective multicentre trial, plasma SAA and CRP levels were measured in patients with severe and mild acute pancreatitis, and in a control group with acute abdominal pain. Plasma samples were collected on admission and at 6-h intervals for 48 h, every 12 h between 48 and 72 h, then daily for 5 days. Plasma SAA was measured by a new enzyme-linked immunosorbent assay and CRP was measured by immunoturbidometry.Results: There were 137 patients with mild and 35 with severe acute pancreatitis, and 74 control patients. SAA levels were signi®cantly higher in patients with severe acute pancreatitis than in those with mild acute pancreatitis, on admission, at 24 h or less after symptom onset, and subsequently. Whereas plasma CRP concentration was also signi®cantly higher in patients with severe acute pancreatitis on admission, it failed to distinguish mild from severe acute pancreatitis until 30±36 h after symptom onset. SAA levels predicted severity (sensitivity 67 per cent, speci®city 70 per cent, negative predictive value 89 per cent, mean(s.d.) area under curve 0´7(0´05)) signi®cantly better than CRP (57 per cent, 60 per cent, 84 per cent, 0´59(0´06) respectively) on admission (P = 0´02) and at 24 h following symptom onset (area under curve 0´65(0´09) versus 0´58(0´09) respectively; P < 0´02).Conclusion: Plasma SAA concentration is an early marker of severity in acute pancreatitis and is superior to CRP estimation on hospital admission and at 24 h or less after symptom onset. This study suggests that plasma SAA concentration is clinically useful, with the potential to replace CRP in the management of acute pancreatitis.

Ultraviolet B Irradiation Reduces the Expression of Adiponectin in Ovarial Adipose Tissues through Endocrine Actions of Calcitonin Gene-Related Peptide-Induced Serum Amyloid A

“…SAA, which is mainly produced in the liver, is the earliest and most sensitive blood marker of acute inflammation [32], [33]. In the present study, UVB stimulation increased the serum SAA level.…”

B Cell Activating Factor of the Tumor Necrosis Factor Family (BAFF) Behaves as an Acute Phase Reactant in Acute Pancreatitis

“…Such a discriminatory capacity of CRP was described in some studies before [16], [17] and confirmed in the present study (Figure 3B). Additionally, we show that simple leucocyte counts also have a great value in monitoring disease activity and recognizing patients that will develop complicated necrotizing disease.…”

Laboratory markers predicting severity of acute pancreatitis

“…SAA itself is able to attract and activate polymorphonuclear (PMN) cells, monocytes and T lymphocytes, and induces the release of chemokines, such as tumor necrosis factor a (TNF-a), IL-1b and IL-8. In contrast to CRP, SAA values were found to differ significantly between mild and severe pancreatitis in a multicenter study by Mayer et al 19 . At a cut-off level of 4418 mg/l, the sensitivity and specificity were 67% and 70%, respectively.…”