• Scand. J. Gastroenterol. · Jan 2008

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

    • Chie Morioka, Masahito Uemura, Tomomi Matsuyama, Masanori Matsumoto, Seiji Kato, Masatoshi Ishikawa, Hiromichi Ishizashi, Masao Fujimoto, Masayoshi Sawai, Motoyuki Yoshida, Akira Mitoro, Junichi Yamao, Tatsuhiro Tsujimoto, Hitoshi Yoshiji, Yasuyuki Urizono, Michiaki Hata, Kenji Nishino, Kazuo Okuchi, Yoshihiro Fujimura, and Hiroshi Fukui.
    • Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan.
    • Scand. J. Gastroenterol. 2008 Jan 1;43(11):1387-96.

    ObjectiveSevere 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 MethodsPlasma ADAMTS13:AC and its related parameters were sequentially determined in 13 SAP patients. ADAMTS13:AC was determined by the chromogenic act-ELISA.ResultsWithin 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.ConclusionsPlasma 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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