MODERN ASPECTS OF PATHOGENESIS AND DIAGNOSIS OF ACUTE PANCREATITIS
I.V. Kolosovych, I.V. Hanol
Bogomolets National Medical University, Kyiv, Ukraine
DOI: https://doi.org/10.15407/fz69.01.084
Abstract
Early adequate treatment of patients with acute pancreatitis
leads to a decrease in mortality and reduces the financial burden
on medical institutions and the patient, which encourages the
continued search for optimal markers for assessing severity
and predicting the course of the disease. The aim of this work
is to study the modern aspects of the pathogenesis of acute
pancreatitis and the role of various biomarkers in the diagnosis
of the severity of the course of the disease and the prediction of
its complications. The study of the features of the pathogenesis
of acute pancreatitis continues, which naturally contributes to
the emergence of new diagnostic markers of this disease. It has
been proven that most of the etiological factors that cause acute
pancreatitis (alcohol, hypoxia, hypercalcemia, hyperlipidemia,
certain pharmacological drugs) also contribute to abnormally
high oscillations of the Ca2+ level. Therefore, it can be
assumed that in acute pancreatitis, Ca2+ is a common trigger
for various etiological factors, which trigger the pathological
process. In turn, the enzymatic cascade is the starting point
for the development of local and systemic inflammatory
reactions, manifested by local and systemic effects. Based on
the study of the features of the course of severe forms of acute
pancreatitis, we established the role of vitamin D deficiency
in the development of the disease. In addition, the study of
the activity of tissue plasminogen activator and/or the level
of thrombin-antithrombin III complex can be interesting
as markers of the development of thrombohemorrhagic
complications. An increase in the number of positive
results of a serological examination for Helicobacter pylori
(immunoglobulin M) in patients with a severe course of acute
pancreatitis after 7 days from the moment of hospitalization
gives reason to consider this indicator as one of the predictors
of the development of purulent complications of the disease.
Preliminary studies using the proposed diagnostic markers give
encouraging results regarding the prognosis for the disease
and the life of this extremely complex category of patients.
Keywords:
acute pancreatitis; pathogenesis; severe course; hemorrhagic and purulent complications; diagnosis; markers.
References
- Argueta PP, Salazar M, Vohra I, Corral JE, Lukens FJ, Vargo JJ, Chahal P, Simons-Linares CR. Thirty- day readmission among patients with alcoholic acute pancreatitis. Dig Dis Sci. 2021 Dec;66(12):4227-36.
CrossRef
PubMed
- Colvin SD, Smith EN, Morgan DE, Porter KK. Acute pancreatitis: an update on the revised Atlanta classification. Abdom Radiol (New York). 2020 May;45(5):1222-31.
CrossRef
PubMed
- Rasslan R, Novo FDCF, Bitran A, Utiyama EM, Rasslan S. Management of infected pancreatic necrosis: state of the art. Rev Col Bras Cir. 2017 Sep-Oct;44(5):521-9.
CrossRef
PubMed
- Choudhuri AH, Duggal S, Biswas PS, Uppal R. A comparison of acute physiology and chronic health evaluation II score and serum procalcitonin change for predicting mortality in acute pancreatitis. Ind J Crit Care Med. 2020 Mar;24(3):190-4.
CrossRef
PubMed PubMedCentral
- Singh P, Garg PK. Pathophysiological mechanisms in acute pancreatitis: Current understanding. Ind J Gastroenterol. 2016 May;35(3):153-66.
CrossRef
PubMed
- Drake M, Dodwad SJ, Davis J, Kao LS, Cao Y, Ko TC. Sex-related differences of acute and chronic pancreatitis in adults. J Clin Med. 2021 Jan 15;10(2):300.
CrossRef
PubMed PubMedCentral
- Roberts SE, Morrison-Rees S, John A, Williams JG, Brown TH, Samuel DG. The incidence and aetiology of acute pancreatitis across Europe. Pancreatology. 2017 Mar-Apr;17(2):155-65.
CrossRef
PubMed
- Kolosovych IV, Hanol IV, Cherepenko IV, Lebedieva KO, Korolova KO. Intrabdominal pressure and its correction in acute surgical pathology. Wiad Lek. 2022;75(2):372-6.
CrossRef
PubMed
- Zheng Z, Ding YX, Qu YX, Cao F, Li F. A narrative review of acute pancreatitis and its diagnosis, pathogenetic mechanism, and management. Ann Transl Med. 2021 Jan;9(1):69.
CrossRef
PubMed PubMedCentral
- Wu H, Ma K, Liao B, Ji T, Zhang S, Cao T. Comparative analysis of early clinical features and complications of different types of acute pancreatitis. Oxid Med Cell Longev. 2022 Jun 25;2022:3771610.
CrossRef
PubMed PubMedCentral
Biczo G, Vegh ET, Shalbueva N, Mareninova OA, Elperin J, Lotshaw E, et al. Mitochondrial dysfunction, through impaired autophagy, leads to endoplasmic reticulum stress, deregulated lipid metabolism, and pancreatitis in animal models. Gastroenterology. 2018 Feb;154(3):689-
CrossRef
PubMed PubMedCentral
- Pallagi P, Görög M, Papp N, Madácsy T, Varga Á, Crul T, et al. Bile acid- and ethanol-mediated activation of Orai1 damages pancreatic ductal secretion in acute pancreatitis. J Physiol. 2022 Apr;600(7):1631-50.
CrossRef
PubMed
- Pallagi P, Madácsy T, Varga Á, Maléth J. Intracellular Ca2+ signalling in the pathogenesis of acute pancreatitis: recent advances and translational perspectives. Int J Mol Sci. 2020 Jun 3;21(11):4005.
CrossRef
PubMed PubMedCentral
- Hegyi P, Rakonczay Z. The role of pancreatic ducts in the pathogenesis of acute pancreatitis. Pancreatology. 2015;15:13-7.
CrossRef
PubMed
- Leppkes M, Maueröder C, Hirth S, Nowecki S, Günther C, Billmeier U, Paulus S, Biermann M, Munoz LE, Hoffmann M, et al. Externalized decondensed neutrophil chromatin occludes pancreatic ducts and drives pancreatitis. Nat Commun. 2016;7:10973.
CrossRef
PubMed PubMedCentral
- Pallagi P, Madácsy T, Varga Á, Maléth J. Intracellular Ca2+ signalling in the pathogenesis of acute pancreatitis: recent advances and translational perspectives. Int J Mol Sci. 2020 Jun 3;21(11):4005.
CrossRef
PubMed PubMedCentral
- Chvanov M, Voronina S, Zhang X, Telnova S, Chard R, Ouyang Y, et al. Knockout of the mitochondrial calcium uniporter strongly suppresses stimulus-metabolism coupling in pancreatic acinar cells but does not reduce severity of experimental acute pancreatitis. Cells. 2020 Jun 5;9(6):1407.
CrossRef
PubMed PubMedCentral
- Swain SM, Romac JM, Shahid RA, Pandol SJ, Liedtke W, Vigna SR, Liddle RA.TRPV4 channel opening mediates pressure-induced pancreatitis initiated by Piezo1 activation. J Clin Invest. 2020 May 1;130(5):2527-41.
CrossRef
PubMed PubMedCentral
- Raraty M, Ward J, Erdemli G, Vaillant C, Neoptolemos JP, Sutton R, Petersen OH. Calcium-dependent enzyme activation and vacuole formation in the apical granular region of pancreatic acinar cells. Proc Natl Acad Sci USA. 2000 Nov 21;97(24):13126-31.
CrossRef
PubMed PubMedCentral
- Fanczal J, Pallagi P, Görög M, Diszházi G, Almássy J, Madácsy T, et al. TRPM2-mediated extracellular Ca2+ entry promotes acinar cell necrosis in biliary acute pancreatitis. J Physiol. 2020 Mar;598(6):1253-70.
CrossRef
PubMed
- Kolosovych IV, Hanol IV, Cherepenko IV. Enteral tube feeding in acute pancreatitis and its complications. World Med Biol. 2021;4 (78):75-9.
CrossRef
- Caluianu EI, Alexandru DO, Georgescu M, Mercu D, Tracă ET, Iancău M. Utilizing multiparameter scores and procalcitonin as prognosis markers for the degree of severity of acute pancreatitis. Curr Health Sci J. 2017 Oct-Dec;43(4):311-17.
- Evans RP, Mourad MM, Pall G, Fisher SG, Bramhall SR. Pancreatitis: preventing catastrophic haemorrhage. World J Gastroenterol. 2017;23:5460-68.
CrossRef
PubMed PubMedCentral
- Silva-Vaz P, Jarak I, Rato L, Oliveira PF, Morgado-Nunes S, Paulino A, et al. Plasmatic oxidative and metabonomic profile of patients with different degrees of biliary acute pancreatitis severity. Antioxidants (Basel). 2021 Jun 21;10(6):988.
CrossRef
PubMed PubMedCentral
- Labarca E, Zubia F, Maraví-Poma E, Martinez F EPAMI Group. Early predictors of abdominal hemorrhage among critically ill patients with pancreatitis: a prospective cohort study. Pancreas. 2018;47:1027-32.
CrossRef
PubMed
- Dumnicka P, Maduzia D, Ceranowicz P, Olszanecki R, Drożdż R, Kuśnierz-Cabala B. The interplay between inflammation, coagulation and endothelial injury in the early phase of acute pancreatitis: clinical implications. Int J Mol Sci. 2017 Feb 8;18(2):354.
CrossRef
PubMed PubMedCentral
- Sharma D, Jakkampudi A, Reddy R, Reddy PB, Patil A, Murthy HVV, et al. Association of systemic inflammatory and anti-inflammatory responses with adverse outcomes in acute pancreatitis: Preliminary results of an ongoing study. Dig Dis Sci. 2017 Dec;62(12):3468-78.
CrossRef
PubMed
- Tang Y, Kong J, Zhou B, Wang X, Liu X, Wang Y, Zhu S. Mesenteric lymph duct ligation alleviates acute lung injury caused by severe acute pancreatitis through inhibition of high mobility group box 1-induced inflammation in rats. Dig Dis Sci. 2021 Dec;66(12):4344-53.
CrossRef
PubMed PubMedCentral
- Badat N, Millet I, Corno L, Khaled W, Boulay-Coletta I, Zins M. Revised Atlanta classification for CT pancreatic and peripancreatic collections in the first month of acute pancreatitis: interobserver agreement. Eur Radiol. 2019 May;29(5):2302-10.
CrossRef
PubMed
- Rompianesi G, Hann A, Komolafe O, Pereira SP, Davidson BR, Gurusamy KS. Serum amylase and lipase and urinary trypsinogen and amylase for diagnosis of acute pancreatitis. Cochrane Database Syst Rev. 2017 Apr 21;4(4):CD012010.
CrossRef
PubMed PubMedCentral
- Tadehara M, Okuwaki K, Imaizumi H, Kida M, Iwai T, Yamauchi H, Kaneko T, Hasegawa R, Miyata E, Kawaguchi Y, Masutani H, Koizumi W. Usefulness of serum lipase for early diagnosis of post-endoscopic retrograde cholangiopancreatography pancreatitis. World J Gastrointest Endosc. 2019 Sep 16;11(9):477-85.
CrossRef
PubMed PubMedCentral
- Basnayake C, Ratnam D. Blood tests for acute pancreatitis. Aust Prescr. 2015 Aug;38(4):128-30.
CrossRef
PubMed PubMedCentral
- Ross JJ, Wasserfall CH, Bacher R, Perry DJ, McGrail K, Posgai AL, et al. Exocrine pancreatic enzymes are a serological biomarker for type 1 diabetes staging and pancreas size. Diabetes. 2021 Apr;70(4):944-54.
CrossRef
PubMed PubMedCentral
- Salinas M, Flores E, López-Garrigós M, Díaz E, Esteban P, Leiva-Salinas C. Application of a continual improvement approach to selecting diagnostic markers for acute pancreatitis in an emergency department. Emergencias. 2017 Abr;29(2):113-16.
- Clark DA, Cuda T, Pretorius C, Edmundson A, Solomon M, Riddell AD. Amylase quantification in the terminal Ileum following formation of an Ileostomy. Sci Rep. 2020 Nov 9;10(1):19368.
CrossRef
PubMed PubMedCentral
- Ismail OZ, Bhayana V. Lipase or amylase for the diagnosis of acute pancreatitis? Clin Biochem. 2017 Dec;50(18):1275-80.
CrossRef
PubMed
- de Oliveira C, Khatua B, Noel P, Kostenko S, Bag A, Balakrishnan B, et al. Pancreatic triglyceride lipase mediates lipotoxic systemic inflammation. J Clin Invest. 2020 Apr 1;130(4):1931-47.
CrossRef
PubMed PubMedCentral
- Wang YY, Qian ZY, Jin WW, Chen K, Xu XD, Mou YP, Zhang W. Acute pancreatitis with abdominal bloating and distension, normal lipase and amylase: A case report. Medicine (Baltimore). 2019 Apr;98(15):e15138.
CrossRef
PubMed PubMedCentral
- Hope A, Bailen EL, Shiel RE, Mooney CT. Retrospective study evaluation of DGGR lipase for diagnosis, agreement with pancreatic lipase and prognosis in dogs with suspected acute pancreatitis. J Small Anim Pract. 2021 Dec;62(12):1092-100.
CrossRef
PubMed
- Rainio M, Lindström O, Udd M, Puolakkainen P, Stenman UH, Kylänpää L. Repeated negative urine trypsinogen-2 dipstick test rules out diagnosis of post-ERCP pancreatitis. J Clin Gastroenterol. 2021 Apr 1;55(4):361-6.
CrossRef
PubMed
- Yasuda H, Kataoka K, Takeyama Y, Takeda K, Ito T, Mayumi T, et al. Usefulness of urinary trypsinogen-2 and trypsinogen activation peptide in acute pancreatitis: A multicenter study in Japan. World J Gastroenterol. 2019 Jan 7;25(1):107-17.
CrossRef
PubMed PubMedCentral
- Wu HC, Wang HP, Chen CC, Wu CH, Liu TH, Wang CH, Shih LN, Liao WC. Urinary trypsinogen-2 level and local complications of acute pancreatitis. J Gastroenterol Hepatol. 2019 Nov;34(11):2043-9.
CrossRef
PubMed
- Kolber W, Dumnicka P, Maraj M, Kuśnierz-Cabala B, Ceranowicz P, Pędziwiatr M, et al. Does the automatic measurement of interleukin 6 allow for prediction of complications during the first 48 h of acute pancreatitis? Int J Mol Sci. 2018 Jun 20;19(6):1820.
CrossRef
PubMed PubMedCentral
- Li G, Chen H, Liu L, Xiao P, Xie Y, Geng X, Zhang T, Zhang Y, Lu T, Tan H, Li L, Sun B. Role of interleukin-17 in acute pancreatitis. Front Immunol. 2021 Sep 14;12:674803.
CrossRef
PubMed PubMedCentral
- Kiss S, Pintér J, Molontay R, Nagy M, Farkas N, Sipos Z, et al. Hungarian pancreatic study group. Early prediction of acute necrotizing pancreatitis by artificial intelligence: A prospective cohort-analysis of 2387 cases. Sci Rep. 2022 May 12;12(1):7827.
CrossRef
- He Q, Ding J, He S, Yu Y, Chen X, Li D, Chen F. The predictive value of procalcitonin combined with C-reactive protein and D dimer in moderately severe and severe acute pancreatitis. Eur J Gastroenterol Hepatol. 2022 Jul 1;34(7):744-50.
CrossRef
PubMed PubMedCentral
- John DS, Aschenbach J, Krüger B, Sendler M, Weiss FU, Mayerle J, Lerch MM, Aghdassi AA. Deficiency of cathepsin C ameliorates severity of acute pancreatitis by reduction of neutrophil elastase activation and cleavage of E-cadherin. J Biol Chem. 2019 Jan 11;294(2):697-707.
CrossRef
PubMed PubMedCentral
- Surbatovic M, Radakovic S. Tumor necrosis factor-α levels early in severe acute pancreatitis: is there predictive value regarding severity and outcome? J Clin Gastroenterol. 2013 Aug;47(7):637-43.
CrossRef
PubMed
- Ruiz-Duque B, Bañuls L, Reinoso-Arija R, Carrasco- Hernandez L, Caballero-Eraso C, Dasí F, Lopez-Campos JL. Methodologies for the determination of blood alpha1 antitrypsin levels: A systematic review. J Clin Med. 2021 Oct 31;10(21):5132.
CrossRef
PubMed PubMedCentral
- Huang W, Altaf K, Jin T, Xiong JJ, Wen L, Javed MA, et al. Prediction of the severity of acute pancreatitis on admission by urinary trypsinogen activation peptide: a meta-analysis. World J Gastroenterol. 2013 Jul 28;19(28):4607-15.
CrossRef
PubMed PubMedCentral
- Deng L, Wang L, Yong F, Xiong J, Jin T, De La Iglesia- Garcia D, et al. Prediction of the severity of acute pancreatitis on admission by carboxypeptidase-B activation peptide: A systematic review and meta- analysis. Clin Biochem. 2015 Jul;48(10-11):740-6.
CrossRef
PubMed
- Yue W, Liu Y, Ding W, Jiang W, Huang J, Zhang J, Liu J. The predictive value of the prealbumin-to-fibrinogen ratio in patients with acute pancreatitis. Int J Clin Pract. 2015 Oct;69(10):1121-8.
CrossRef
PubMed
- Al-Qahtani HH, Alam MKh, Waheed M. Comparison of harmless acute pancreatitis score with ranson's score in predicting the severity of acute pancreatitis. J Coll Phys Surg Pak. 2017 Feb;27(2):75-9.
- Silva-Vaz P, Abrantes AM, Morgado-Nunes S, Castelo- Branco M, Gouveia A, Botelho MF, Tralhão JG. Evaluation of prognostic factors of severity in acute biliary pancreatitis. Int J Mol Sci. 2020 Jun 16;21(12):4300.
CrossRef
PubMed PubMedCentral
- Blum CA, Velly L, Brochet C, Ziegler F, Tavolacci MP, Hausfater P, Lvovschi VE. Relevance of cortisol and copeptin blood concentration changes in an experimental pain model. Sci Rep. 2022 Mar 19;12(1):4767.
CrossRef
PubMed PubMedCentral
- Chen Y, Ke L, Meng L, Yang Q, Tong Z, Pan Y, Li W, Li J. Endothelial markers are associated with pancreatic necrosis and overall prognosis in acute pancreatitis: A preliminary cohort study. Pancreatology. 2017 Jan- Feb;17(1):45-50.
CrossRef
PubMed
- Jaworek J, Leja-Szpak A, Nawrot-Porąbka K, Szklarczyk J, Kot M, Pierzchalski P, Góralska M, Ceranowicz P, Warzecha Z, Dembinski A, Bonior J. Effects of melatonin and its analogues on pancreatic inflammation, enzyme secretion, and tumorigenesis. Int J Mol Sci. 2017 May 8;18(5):1014.
CrossRef
PubMed PubMedCentral
- Kumar A, Bhatia M. Role of hydrogen sulfide, substance P and adhesion molecules in acute pancreatitis. Int J Mol Sci. 2021 Nov 9;22(22):12136.
CrossRef
PubMed PubMedCentral
- Gumpper K, Dangel AW, Pita-Grisanti V, Krishna SG, Lara LF, Mace T, Papachristou GI, Conwell DL, Hart PA, Cruz-Monserrate Z. Lipocalin-2 expression and function in pancreatic diseases. Pancreatology. 2020 Apr;20(3):419-24.
CrossRef
PubMed PubMedCentral
- Gravito-Soares M, Gravito-Soares E, Gomes D, Almeida N, Tomé L. Red cell distribution width and red cell distribution width to total serum calcium ratio as major predictors of severity and mortality in acute pancreatitis. BMC Gastroenterol. 2018 Jul 5;18(1):108.
CrossRef
PubMed PubMedCentral
- Kolosovych IV, Hanol IV. The role of phosphorus-calcium homeostasis and vitamin D in the pathogenesis of acute pancreatitis and assessment of its severity. Fiziol Zh. 2022; 68(3): 61-7.
CrossRef
- Li H, Xu Y, Zhou X, Jin T, Wang Z, Sun Y, Wang H, Jiang D, Yin C, Shen B, Song K. DIA-based proteomic analysis of plasma protein profiles in patients with severe acute pancreatitis. Molecules. 2022 Jun 17;27(12):3880.
CrossRef
PubMed PubMedCentral
- Wos-Wroniewicz E, Caban M, Malecka-Panas E. Role of adipokines in the assessment of severity and predicting the clinical course of acute pancreatitis. J Physiol Pharmacol. 2020 Oct;71(5).
- Vitale DS, Lahni P, Hornung L, Thompson T, Farrell PR, Lin TK, Nathan JD, Wong HR, Abu-El-Haija M. Matrix metalloproteinases and their inhibitors in pediatric severe acute pancreatitis. PLoS One. 2022 Feb 14;17(2):e0261708.
CrossRef
PubMed PubMedCentral
- Shen D, Tang C, Zhu S, Huang G. Macrophage migration inhibitory factor is an early marker of severe acute pancreatitis based on the revised Atlanta classification. BMC Gastroenterol. 2021 Jan 22;21(1):34.
CrossRef
PubMed PubMedCentral
- Xu WB, Hu QH, Wu CN, Fan ZK, Song ZF. Serum soluble fibrinogen-like protein 2 concentration predicts delirium after acute pancreatitis. Brain Behav. 2019 Apr;9(4):e01261.
CrossRef
PubMed PubMedCentral
- Lv Y, Yao Y, Liu Q, Lei J. Accuracy of angiopoietin-2 for predicting organ failure in patients with acute pancreatitis: a systematic review and meta-analysis. J Int Med Res. 2021 Feb;49(2):300060520986708.
CrossRef
PubMed PubMedCentral
- Gao J, Chen S, Kong T, Wen D, Yang Q. The relationship between soluble CD73 and the incidence of septic shock in severe sepsis patients: a cross-sectional analysis of data from a prospective FINNAKI study. Ann Transl Med. 2022 Mar;10(6):302.
CrossRef
PubMed PubMedCentral
- Dumnicka P, Maduzia D, Ceranowicz P, Olszanecki R, Drożdż R, Kuśnierz-Cabala B. The interplay between inflammation, coagulation and endothelial injury in the early phase of acute pancreatitis: Clinical implications. Int J Mol Sci. 2017 Feb 8;18(2):354.
CrossRef
PubMed PubMedCentral
- Yang N, Hao J, Zhang D. Antithrombin III and D-dimer levels as indicators of disease severity in patients with hyperlipidaemic or biliary acute pancreatitis. J Int Med Res. 2017 Feb;45(1):147-58.
CrossRef
PubMed PubMedCentral
- Wan J, Yang X, He W, Zhu Y, Zhu Y, Zeng H, Liu P, Xia L, Lu N. Serum D-dimer levels at admission for prediction of outcomes in acute pancreatitis. BMC Gastroenterol. 2019 May 2;19(1):67.
CrossRef
PubMed PubMedCentral
- Kolosovych IV, Hanol IV. Hemocoagulation factors of hemorrhagic complications in acute pancreatitis. Fiziol Zh. 2022; 68(1): 56-61.
CrossRef
- Ye W, Hu Y, Zhang R, Ying K. Diagnostic value of the soluble triggering receptor expressed on myeloid cells-1 in lower respiratory tract infections: a meta-analysis. Respirology. 2014 May;19(4):501-7.
CrossRef
PubMed
- Gulfo J, Ledda A, Gea-Sorlí S, Bonjoch L, Closa D, Grasa M, Esteve M. New roles for corticosteroid binding globulin and opposite expression profiles in lung and liver. PLoS One. 2016 Jan 7;11(1):e0146497.
CrossRef
PubMed PubMedCentral
- Kasian VV, Sheiko VD, Mamontova TV, Vesnina LE, Shlykova OA. Procalcitonin in early prediction of acute severe pancreatitis. Wiad Lek. 2020;73(7):1370-2.
CrossRef
PubMed
- Paliwal A, Nawal CL, Meena PD, Singh A. A Study of procalcitonin as an early predictor of severity in acute pancreatitis. J Assoc Phys Ind. 2022 Apr;70(4):11-2.
- Kolosovych IV, Hanol IV. Purulent septic complications of acute pancreatitis and their pathogenetic relationship with helicobacter pylori. Novosti Khirurgii. 2021 Oct- Nov; (5): 542-8.
CrossRef
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