Evaluation of the relationship between serum SuPAR (Soluble urokinase plasminogen activator receptor) levels and disease severity in acute pancreatitis patients

Objective: Acute pancreatitis (AP) is a diffuse inflammatory disease of the exocrine pancreas that can cause severe abdominal pain, pancreatic necrosis and multiple organ dysfunction, with a mortality of 1-5%. Mild AP (MAP) is characterized by the absence of organ failure and no local or systemic complications. Moderate AP (MSAP) is characterized by transient organ failure (resolves within 48 hours) or local or systemic complications. Severe AP (SAP) is characterized by the development of permanent organ failure (lasting longer than 48 hours) involving one or more organs. SuPAR protein is found in blood and other organic fluids after leaving the cell surface. It is involved in various immunological functions including cell adhesion, migration, chemotaxis, proteolysis, immune activation, tissue remodeling, invasion and signal transduction. In our study, we aimed to classify the AP patient group according to severity and to evaluate the relationship between serum suPAR levels and AP severity. Materials and Methods: Our study was conducted with 130 patients with acute pancreatitis aged 18-80 years and 50 healthy volunteers admitted to our hospital between 30.10.2021 and 30.06.2022. Patients were grouped according to demographic characteristics, etiology of the disease, laboratory parameters and Atlanta classification. Patients were classified as MAP, MSAP and SAP. Patient and control groups were evaluated according to serum suPAR levels. Statistical analysis of the data obtained was performed. Results: In this study conducted at Necmettin Erbakan University Meram Medical Faculty Hospital, 130 FP patients and 50 healthy individuals were included. Among the patients, 53.1% (n=69) were female and 46.9% (n=61) were male. In the control group, 54% (n=27) were female and 46% (n=23) were male. The mean age of the acute pancreatitis patients was 55.53 ± 18.01 years and the mean age of the control group was 51.20 ± 6.6 years. When the etiologic causes were analyzed in AP patients, gallstones were ranked first with 76.9% (n=100). AKI (Acute kidney injury) developed in 20% (n=26) of AP patients. Of the patients with AKI, 84.6% (n=22) were found to be stage 1. Among the hematologic parameters, leukocyte, neutrophil, and RDW (Erythrocyte distribution width) values were statistically significantly higher (p<0.001) and lymphocyte, hematocrit (Hct), and platelet (PLT) values were statistically significantly lower in the AP group compared to the control group (p values, respectively p<0.001, p=0.011, p=0.038,). Regardless of the stage, suPAR level was not statistically significant in the AP patient group compared to the control group, but it was found to be higher in the patient group compared to the control group. NLR (neutrophil to lymphocyte ratio), PLR (platelet to lymphocyte ratio), SII Index (systemic immune inflammation index), SIRI (systemic immune response index) values were statistically significantly higher in the patient group compared to the control group (p<0.001). CRP (c reactive protein), AST (aspartate transaminase), ALT (alanine transaminase), LDH (lactate dehydrogenase), amylase, lipase, glucose values were statistically significantly higher in the patient group compared to the control group (p<0.001). Mild AP was found in 51.6% (n=67), moderate AP in 44.6% (n=58) and SAP in 3.8% (n=5) of the patients. Statistically significant differences were found in length of hospitalization, leukocyte, neutrophil, monocyte, CRP, creatinine, calcium, suPAR values when comparing mild, moderate and severe AP (p values respectively p<0.001, p=0.006, p=0.006, p=0.021, p=0.016, p=0.015, p=0.014, p=0.026, p=0.028,). There was a significant positive correlation between SuPAR and Ranson score (r=0.183, p=0.037). There was a significant positive correlation between SuPAR and Bisap score (r=0.193, p=0.028). There was a significant positive correlation between SuPAR and Atlanta classification (r=0.263, p=0.002). There was a statistically significant positive correlation between SuPAR and AKI (r=0.288, p=0.001). There was a significant positive correlation between SuPAR and length of hospitalization (r=0.183 p=0.037). The area under the ROC curve was calculated to determine the role of SuPAR in predicting SAP; AUC=0.687, p=0.15. SuPAR level as an inflammatory biomarker increased with disease severity, but no statistically significant results were obtained. Conclusion: In our study, serum suPAR levels increased with AP severity and the correlation of suPAR with AKI is promising. However, the number of patients in our study was limited and studies with a larger patient population are needed.