• Mikael Maksimow, Lea Kyhälä, Anne Nieminen, Leena Kylänpää, Kristiina Aalto, Kati Elima, Panu Mentula, Mari Lehti, Pauli Puolakkainen, Gennady G Yegutkin, Sirpa Jalkanen, Heikki Repo, and Marko Salmi.
• 1MediCity Research Laboratory, University of Turku, Turku, Finland. 2Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland. 3Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland. 4Department of Medical Biochemistry and Genetics, University of Turku, Turku, Finland. 5Inflammatory Mechanisms Unit, National Institute for Health and Welfare, Turku, Finland. 6Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland.
• Crit. Care Med.. 2014 Dec 1;42(12):2556-64.

ObjectiveNew biomarkers are needed to better predict the severity of acute pancreatitis. CD73/ecto-5'-nucleotidase is an enzyme that generates adenosine, which dampens inflammation and improves vascular barrier function in several disease models. CD73 also circulates in a soluble form in the blood. We studied whether levels of soluble form of CD73 predict the development of organ failure in acute pancreatitis.DesignA prospective cohort study of patients with acute pancreatitis from 2003 to 2007.SettingAdmissions to the biggest tertiary care hospital in Finland.PatientsOne hundred sixty-one patients with acute pancreatitis, of which 107 were subclassified according to the revised Atlanta criteria into mild, 29 into moderately severe and 25 into severe.InterventionsNone.Measurements And Main ResultsSerum and blood cell samples were collected at admission. Protein levels of soluble form of CD73 in serum were determined using a novel enzyme-linked immunosorbent assay, activity of soluble form of CD73 using radioactive enzyme assays, and CD73 messenger RNA levels from leukocytes using quantitative polymerase chain reaction. Activity and protein concentration of soluble form of CD73, and messenger RNA level of CD73 all decreased along with the disease severity (p ≤ 0.01 for all). The activity of soluble form of CD73 at admission predicted the development of the severe pancreatitis in different groups of the patients. The area under the receiver-operating characteristic curve value for activity of soluble form of CD73 was 0.65 (95% CI, 0.51-0.80) among a subgroup of patients comprising moderately severe and severe disease, 0.79 (95% CI, 0.69-0.88) among all patients including mild pancreatitis, and 0.75 (95% CI, 0.60-0.89) among patients who had no signs of organ failure (modified Marshall score < 2) at admission. Especially, in the last-mentioned group, activity of soluble form of CD73 was better than C-reactive protein or creatinine in predicting the severe pancreatConclusions: Activity of soluble form of CD73 at admission to hospital has prognostic value in predicting the development of the severe form of acute pancreatitis.

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