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Microproteinuria Predicts Organ Failure in Patients Presenting with Acute Pancreatitis
Sara Bertilsson1, Per Swärd2, Anders Håkansson3
1Department of Clinical Sciences Lund, Gastroenterology and Hepatology, Faculty of Medicine, Lund University, Lund, Sweden.
Background And Aims:
The disease course of acute pancreatitis (AP) ranges from mild and self-limiting to severe inflammation, associated with significant morbidity and mortality. At present, there are no universally accepted and reliable predictors for severity. Microproteinuria has been associated with the presence of systemic inflammatory response syndrome as well as trauma, although its association with AP is not well understood. The aim of this study was to investigate the value of microproteinuria to predict development of organ failure in AP.
Methods:
Consecutive AP patients were prospectively enrolled. Urine samples were collected upon admission, 12-24 h after admission, and 3 months post-discharge for calculation of urine α1-microglobulin-, albumin-, IgG-, and IgM/creatinine ratios. Data regarding AP etiology, severity, and development of organ failure were registered.
Results:
Overall, 92 AP patients were included (14 % with organ failure; 6 % with severe AP). The α1-microglobulin-, albumin-, and IgG/creatinine ratios correlated with high-sensitivity C-reactive protein 48 h after admission (r = 0.47-0.61, p < 0.001 for all). They were also significantly higher in patients with versus without organ failure (p < 0.05 for all). The α1-microglobulin/creatinine ratio upon admission predicted organ failure [adjusted odds ratio 1.286, 95 % confidence interval (CI) 1.024-1.614] with similar accuracy (AUROC 0.81, 95 % CI 0.69-0.94) as the more complex APACHE II score (AUROC 0.86, 95 % CI 0.70-1.00).
Conclusion:
The α1-microglobulin/creatinine ratio upon presentation with AP is related to inflammation and predicts development of organ failure. Further studies are warranted to evaluate its potential usefulness in predicting outcome for AP patients.
Insights
Microproteinuria, specifically the alpha-1-microglobulin/creatinine ratio, can predict organ failure in acute pancreatitis (AP) patients. This simple urine test shows promise as a reliable severity predictor for AP.
Area of Science:
- Nephrology
- Gastroenterology
- Critical Care Medicine
Background:
- Acute pancreatitis (AP) severity prediction lacks reliable markers.
- Microproteinuria is linked to systemic inflammation but its role in AP is unclear.
Purpose of the Study:
- To assess microproteinuria's value in predicting organ failure in AP patients.
- Investigate urine alpha-1-microglobulin/creatinine ratio as a severity marker.
Main Methods:
- Prospective enrollment of 92 AP patients.
- Urine samples collected for alpha-1-microglobulin, albumin, IgG, IgM/creatinine ratios.
- Correlation with C-reactive protein and organ failure development.
Main Results:
- Urine ratios correlated with C-reactive protein and were higher in patients with organ failure.
- Alpha-1-microglobulin/creatinine ratio predicted organ failure (aOR 1.286).
- Prediction accuracy (AUROC 0.81) was comparable to APACHE II score.
Conclusions:
- Urine alpha-1-microglobulin/creatinine ratio reflects inflammation in AP.
- This ratio predicts organ failure development in AP patients.
- Further research is needed to confirm its clinical utility for AP outcome prediction.
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