The predictive efficacy of dynamic level changes of plasma endothelial microparticles and plasma soluble thrombomodulin on the prognosis of severe acute pancreatitis.

Abstract

Objective: To investigate the predictive efficacy of dynamic level changes of plasma endothelial microparticles (EMP) and plasma soluble thrombomodulin (sTM) on the prognosis of severe acute pancreatitis (SAP).

Methods: This study retrospectively selected 128 eligible SAP patients admitted to our hospital from May 2021 to April 2023. According to the final outcome, the patients were grouped as the survival group (n = 95) and death group (n = 33). The EMP, sTM and microcirculation related indexes (lactic acid level, central venous pressure (CVP), mean arterial pressure (MAP)) of SAP patients were monitored at admission, 24 h, 48 h and 72 h after admission. Pearson was adopted to analyze the correlation between EMP and sTM levels with microcirculation disorder related indicators. The levels of EMP and sTM were compared between the survival group and the death group. The EMP high level group was ≥ 150.00 ng / mL, and the EMP low level group was < 150.00 ng / mL. The sTM high-level group was ≥ 300.00 ng / mL, and the low-level group was < 300.00 ng / mL. The differences in survival curves between different groups were compared by Kaplan-Meier. AUC was used to analyze the prognostic value of EMP and sTM levels alone and in combination in SAP patients.

Results: Compared with admission, the levels of EMP, sTM, lactic acid and CVP in 128 SAP patients were all significantly increased at 24 h, 48 h and 72 h after admission, but the MAP was largely decreased (p < 0.05). EMP and sTM were positively correlated with lactic acid and CVP respectively, but negatively correlated with MAP (p < 0.05). The death group had much higher levels of EMP and sTM than the survival group (p < 0.05). From the perspective of 1-year survival rate, the high-level group of EMP was lower than the low-level group (p < 0.05) and the high-level group of sTM was lower than the low-level group (p < 0.05). ROC curve analysis confirmed that the sensitivity and specificity of combined detection were 92.39% and 90.54%, respectively, with the AUC of 0.903 (95%CI:0.863-0.928), which was significantly higher than that of single detection (p < 0.05).

Conclusion: The levels of EMP and sTM were significantly increased in SAP patients, which were closely related to microcirculation disorders and poor prognosis. The combined detection of EMP and sTM has significant prognostic value in SAP.