Venegas-Tamayo Ana Rocío, Peña-Veites Olga Mariel, Hernández-González Martha Alicia, Barrientos-Alvarado Cornelio
High Specialty Medical Unit No. 1, National Medical Center of Bajío, Mexican Social Security Institute, Leon 37320, Guanajuato, Mexico.
Department of Physiology, Higher School of Medicine, National Polytechnic Institute, Mexico City 11340, Mexico.
Life (Basel). 2023 Jul 21;13(7):1602. doi: 10.3390/life13071602.
High-density lipoprotein cholesterol (HDL-C) is reported as a biomarker of systemic inflammation and multi-organ failure (MOF), which has been rarely investigated in acute pancreatitis (AP), a frequent condition in the emergency department (ED). The objective was to study the predictive capacity of the decrease in HDL-C to the progression of MOF in AP in the ED; analyzing 114 patients with AP for one year in a longitudinal and prospective study, AP severity was obtained by the Atlanta classification, in relation to modified Marshall and Bedside Index for Severity in Acute Pancreatitis (BISAP) scores, and clinical and laboratory parameters in a 48 h hospital stay. The area under the receiver operating characteristic (ROC) curve was used to estimate the validity of the predictor and define optimal cut-off points. It was found that AP was classified as severe in 24.5%, mainly for biliary etiology (78.9%) and female sex (73.6%). As a biomarker, HDL-C decreased from 31.6 to 29.5 mg/dL in a 48 h stay ( < 0.001), correlating negatively with the increase in severity index > 2 and the modified Marshall ( < 0.032) and BISAP ( < 0.009) scores, finding an area under the ROC curve with a predictive capacity of 0.756 (95% CI, 0.614-0.898; < 0.004) and a cut-off point of 28.5 mg/dL (sensitivity: 79%, specificity: 78%), demonstrating that the decrease in HDL-C levels serves as a useful indicator with a predictive capacity for MOF in mild to severe AP, during a 48 h hospital stay in the ED.
高密度脂蛋白胆固醇（HDL-C）被报道为全身炎症和多器官功能衰竭（MOF）的生物标志物，在急性胰腺炎（AP）中鲜有研究，而AP是急诊科常见病症。目的是研究HDL-C降低对急诊科AP患者MOF进展的预测能力；在一项纵向前瞻性研究中，对114例AP患者进行了为期一年的分析，通过亚特兰大分类法确定AP严重程度，并与改良马歇尔评分和急性胰腺炎床边严重程度指数（BISAP）评分以及患者住院48小时期间的临床和实验室参数进行关联。采用受试者工作特征（ROC）曲线下面积来评估预测指标的有效性并确定最佳截断点。结果发现，24.5%的AP患者被归类为重症，主要病因是胆源性（78.9%）和女性（73.6%）。作为生物标志物，HDL-C在48小时住院期间从31.6降至29.5mg/dL（<0.001），与严重程度指数>2以及改良马歇尔评分（<0.032）和BISAP评分（<0.009）的升高呈负相关，ROC曲线下面积的预测能力为0.756（95%CI，0.614 - 0.898；<0.004），截断点为28.5mg/dL（敏感性：79%，特异性：78%），表明HDL-C水平降低是一个有用的指标，对急诊科48小时住院期间轻至重度AP患者的MOF具有预测能力。
