Serum Renin: An Early Biomarker for Predicting Severe Acute Pancreatitis

Acute pancreatitis stems from pancreatic acinar injury leading to autodigestion and inflammation. Most cases are self-limiting, but severe acute pancreatitis involves prolonged hospitalization and mortality up to 50%. Current predictors lack early sensitivity or require 24-48 hours for assessment. Reliable early biomarkers are essential for timely triage and de-escalation. This study examined admission serum renin as an early severe acute pancreatitis predictor, hypothesizing renin-angiotensin system activation from hypovolemia.

In this prospective cohort study conducted at a tertiary center from October 12, 2023, to September 29, 2024, serum renin levels were measured upon admission in 240 patients with acute pancreatitis and the predictive performance for severe acute pancreatitis was compared with the APACHE II and BISAP scores calculated at the 24th hour of admission, as well as the Ranson's criteria calculated at 48th hour of admission.

The cutoff of ≥ 2400 pg/mL yielded an AUC of 0.870 (95% CI: 0.784-0.925), with a sensitivity of 86.1% and negative predictive value of 97.6%, performing as effectively as the scoring systems. High-renin patients had high rates of necrotizing pancreatitis, severe acute pancreatitis (32.9% vs. 2.4%), ICU admission (32.9% vs. 9.1%), and mortality (13.2% vs. 1.2%). Decision curve analysis showed serum renin's highest net benefit at 10-20% thresholds.

Admission serum renin emerges as a robust early biomarker for predicting severe acute pancreatitis, with high sensitivity and negative predictive value enabling timely triage and de-escalation. Its immediate accessibility surpasses delayed tools, potentially reducing mortality and costs.