Serum GAS6 is useful biomarker for identifying patients with severe acute pancreatitis within 24 h of admission: a multi-cohort analysis of 869 patients

IF 3.9 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology Pub Date : 2026-06-01 Epub Date: 2026-04-04 DOI:10.1016/j.pan.2026.04.009

Xiuli Zhang , Kaixin Peng , Yunpeng Peng , Jiongdi Lu , Hanzhang Deng , Bin Li , Zipeng Lu , Feng Cao , Qiang Li , Li Wen

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引用次数: 0

Abstract

Objectives

Early identification of severe acute pancreatitis (SAP) within 24 h of admission remains challenging and specific biomarkers reflecting the underlying mechanisms, particularly pancreatic necrosis, are lacking. We have previously identified a crucial role of AXL and MERTK in regulating pancreatic necrosis. Their ligands, Growth Arrest-Specific 6 (GAS6) and Protein S (PROS1) can be detected in serum. Therefore, this study aims to evaluate the value of serum GAS6 and PROS1 levels within 24 h of admission for identifying SAP.

Methods

Serum GAS6 and PROS1 were initially assessed in a retrospective discovery cohort and subsequently validated in a prospective cohort using ELISA. A subset of patients provided serial serum samples over 4 weeks to analyze temporal dynamics and correlations with disease severity.

Results

A total of 869 AP patients were enrolled. Serum GAS6 levels were significantly elevated and PROS1 levels reduced compared with healthy controls, with greater changes in moderately severe and severe cases. As a single marker, GAS6 showed robust performance for predicting SAP (AUC = 0.722, 95%CI: 0.620-0.832), outperforming CRP (AUC = 0.595) and BUN (AUC = 0.681), and comparable to SIRS (AUC = 0.659), BISAP (AUC = 0.755), and APACHE-II (AUC = 0.797). The GAS6+BISAP combination yielded an AUC of 0.818, significantly superior to GAS6 alone (p = 0.001), SIRS (p = 0.013), CRP (p = 0.002), and BUN (p = 0.015), and numerically higher than APACHE-II (0.818 vs. 0.797). The temporal dynamic changes of both further correlated with disease severity.

Conclusions

Serum levels of GAS6 measured within 24 h provide a valuable, rapid approach for identifying SAP, and when combined with established scoring systems, can further improve performance.

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血清GAS6是入院24小时内识别严重急性胰腺炎患者的有用生物标志物：一项869例患者的多队列分析。

目的：入院24小时内早期识别严重急性胰腺炎（SAP）仍然具有挑战性，缺乏反映潜在机制的特异性生物标志物，特别是胰腺坏死。我们之前已经确定了AXL和MERTK在调节胰腺坏死中的关键作用。它们的配体生长抑制特异性6 （GAS6）和蛋白S （PROS1）可在血清中检测到。因此，本研究旨在评估入院24小时内血清GAS6和PROS1水平对识别sap的价值。方法：在回顾性发现队列中初步评估血清GAS6和PROS1水平，随后使用ELISA在前瞻性队列中进行验证。一部分患者在4周内连续提供血清样本，以分析时间动态及其与疾病严重程度的相关性。结果：共纳入869例AP患者。与健康对照组相比，血清GAS6水平显著升高，PROS1水平显著降低，中重度和重度病例变化更大。作为单一标记物，GAS6在预测SAP （AUC = 0.722, 95%CI: 0.620-0.832）方面表现稳健，优于CRP （AUC = 0.595）和BUN (AUC = 0.681)，与SIRS （AUC = 0.659）、BISAP （AUC = 0.755）和APACHE-II （AUC = 0.797）相当。GAS6+BISAP联合治疗的AUC为0.818，显著优于GAS6单独治疗（p = 0.001）、SIRS （p = 0.013）、CRP （p = 0.002）和BUN (p = 0.015)，数值上高于APACHE-II （0.818 vs. 0.797）。两者的时间动态变化与疾病严重程度进一步相关。结论：24小时内测定血清GAS6水平为SAP的鉴定提供了一种有价值的、快速的方法，当与已建立的评分系统相结合时，可以进一步提高性能。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pancreatology 医学-胃肠肝病学

CiteScore

7.20

自引率

5.60%

发文量

194

审稿时长

44 days

期刊介绍： Pancreatology is the official journal of the International Association of Pancreatology (IAP), the European Pancreatic Club (EPC) and several national societies and study groups around the world. Dedicated to the understanding and treatment of exocrine as well as endocrine pancreatic disease, this multidisciplinary periodical publishes original basic, translational and clinical pancreatic research from a range of fields including gastroenterology, oncology, surgery, pharmacology, cellular and molecular biology as well as endocrinology, immunology and epidemiology. Readers can expect to gain new insights into pancreatic physiology and into the pathogenesis, diagnosis, therapeutic approaches and prognosis of pancreatic diseases. The journal features original articles, case reports, consensus guidelines and topical, cutting edge reviews, thus representing a source of valuable, novel information for clinical and basic researchers alike.