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Original Article

Plasma ADAMTS13 activity parallels the APACHE II score, reflecting an early prognostic indicator for patients with severe acute pancreatitis

Chie Morioka Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan

Masahito Uemura Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, JapanCorrespondence[email protected]

, MD,

Tomomi Matsuyama Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan

Masanori Matsumoto Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Nara, Japan

Seiji Kato Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Nara, Japan

Masatoshi Ishikawa Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan

Hiromichi Ishizashi Department of Health and Sports Science, Nara Medical University, Kashihara, Nara, Japan

Masao Fujimoto Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan

Masayoshi Sawai Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan

Motoyuki Yoshida Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan

Akira Mitoro Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan

Junichi Yamao Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan

Tatsuhiro Tsujimoto Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan

Hitoshi Yoshiji Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan

Yasuyuki Urizono Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan

Michiaki Hata Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan

Kenji Nishino Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan

Kazuo Okuchi Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan

Yoshihiro Fujimura Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Nara, Japan

Hiroshi Fukui Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan

show all

Abstract

Objective. Severe acute pancreatitis (SAP) frequently progresses to pancreatitis-associated multiorgan failure (MOF) with high mortality. Decreased plasma ADAMTS13 activity (ADAMTS13:AC) results in the accumulation of unusually large von Willebrand factor multimers (UL-VWFM) and the formation of platelet thrombi, ultimately leading to MOF. The purpose of the study was to investigate the potential role of ADAMTS13:AC in the severity of SAP. Material and methods. Plasma ADAMTS13:AC and its related parameters were sequentially determined in 13 SAP patients. ADAMTS13:AC was determined by the chromogenic act-ELISA. Results. Within 1 or 2 days after admission, ADAMTS13:AC was lower in SAP patients (mean 28%) than in healthy controls (99%), and gradually recovered in the 11 survivors but further decreased in the 2 non-survivors. Patients with higher sepsis-related organ failure assessment (SOFA) scores showed lower ADAMTS13:AC than those without these scores. The inhibitor against ADAMTS13 was undetectable. On day 1, von Willebrand factor antigen (VWF:Ag) was higher (402%, p<0.001) in SAP patients than in controls (100%). VWF:Ag gradually decreased in the survivors, except in the 3 patients needing a necrosectomy, but remained high in the non-survivors. ADAMTS13:AC was inversely correlated with the APACHE II score (r=−0.750, p<0.005), and increased plasma concentrations of interleukin 6 (IL-6) and IL-8 at admission. UL-VWFM-positive patients had lower ADAMTS13:AC and decreased serum calcium concentrations, but higher VWF:Ag and IL-8 concentrations than UL-VWFM-negative patients. Conclusions. Plasma ADAMTS13:AC was closely related to the APACHE II score. This intimate relationship may serve as an early prognostic indicator for SAP patients. The imbalance between decreased ADAMTS13:AC and increased UL-VWFM could contribute to SAP pathogenesis through enhanced thrombogenesis.

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Plasma ADAMTS13 activity parallels the APACHE II score, reflecting an early prognostic indicator for patients with severe acute pancreatitis

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Plasma ADAMTS13 activity parallels the APACHE II score, reflecting an early prognostic indicator for patients with severe acute pancreatitis

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