The Relationship Between Pancreatic Enzyme Release and Activation and the Acute-Phase Protein Response in Patients with Acute Pancreatitis

Useful Markers for Predicting Severity and Monitoring Progression of Acute Pancreatitis

“…Moreover, experimentally it has been shown that there are significant quantities of trypsinogen in the interstitial compartment and the systemic circulation, suggesting that activation may cause autodigestion of the gland and systemic organ failure [57][58][59][60]. A positive correlation between the degree of protease activation and the extent of pancreatic injury in the course of acute pancreatitis has been shown [61][62][63][64]. However, experimental studies have shown that increased trypsinogen activation is only a temporary phenomenon in acute pancreatitis [54,65,66].…”

Severe acute pancreatitis is related to increased early urinary levels of the activation peptide of pancreatic phospholipase A2

“…Although the levels of urinary PROP could be used to predict severe disease, there was no correlation with the development of distant organ failure per se. Heath et al [12] showed that the urinary PROP/creatinine ratio peaked 13-24 h following the onset of symptoms in a small series of severe cases with acute pancreatitis. This ratio returned to normal 25-36 h after symptom onset and then rose steadily to similar peak levels over the next 96 h. Comparison with the present study is not possible, because the actual urinary PROP values were not given [12].…”

“…Heath et al [12] showed that the urinary PROP/creatinine ratio peaked 13-24 h following the onset of symptoms in a small series of severe cases with acute pancreatitis. This ratio returned to normal 25-36 h after symptom onset and then rose steadily to similar peak levels over the next 96 h. Comparison with the present study is not possible, because the actual urinary PROP values were not given [12]. Another small clinical study reported that the plasma PROP levels were actually lower in severe as compared with mild acute pancreatitis [13].…”

“…Since there have only been two small previous studies of PROP in patients with acute pancreatitis with apparently conflicting results [12,13], we report the findings of a large prospective multicentre study.…”

Clinical Value of Severity Markers in Acute Pancreatitis

“…PLAP peak values were seen 12 and 24 h after symptom onset, preceding the increase of IL-6 and CRP (60). CAPAP discriminates well between severe and mild acute pancreatitis (63,64).…”