The potential role of BMI, plasma leptin, nesfatin-1 and ghrelin levels in the early detection of pancreatic necrosis and severe acute pancreatitis: A prospective cohort study

Background: Early prediction of disease severity in acute pancreatitis (AP) is crucial. The aim of this study was to investigate the body-mass index (BMI), plasma leptin, nesfatin-1 and ghrelin levels as potential markers predicting peripancreatic necrosis and severity in acute pancreatitis. Methods: In the study period, 97 consecutive patients with AP were prospectively analysed. Severe AP was defined according to the Atlanta Criteria. BMI was also calculated. To measure plasma Leptin, Nesfatin-1 and Ghrelin concentrations, the blood samples were obtained from patients within 24 hours of admission. Results: Out of 97 patients, 92(70 females, 22 males) were considered eligible for analysis. Of the 92 patients, 30 patients (32.6%) were assessed as severe pancreatitis. BMI and leptin levels were significantly higher in patients with severe pancreatitis. The pooled sensitivity and specificity of BMI as a predictor for the development of pancreatic necrosis were 0.90(95% CI = 0.56-0.99) and 0.70(95% CI = 0.58-0.79), respectively; with an overall area under curve value of 0.78. The pooled sensitivity and specificity of leptin levels as a predictor for development of pancreatic necrosis were 1(95% CI = 0.69-1) and 0.73(95% CI = 0.62-0.82), respectively; with an overall area under curve value of 0.82. Nesfatin-1 and ghrelin levels showed no significant difference in patients with mild pancreatitis (6.97 +/- 0.84 ng/ml and 2.3(1.0-9.9); respectively) and severe pancreatitis (6.74 +/- 0.65 ng/ml and 2.0(1.9-9.9); respectively) (p = 0.1923 and 0.8531; respectively). Conclusion: BMI and plasma leptin levels both were correlated with the severity of pancreatitis. Leptin levels showed better area under the curve, sensitivity and specificity values compared to BMI in prediction of pancreatic necrosis. Nesfatin-1 and ghrelin levels were not found to be predictors of the severity of disease. (C) 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.