Changes of serum neopterin and its significance as biomarker in prediction the prognosis of patients with acute pancreatitis

Objectives: To investigate the dynamic changes of serum neopterin and its significance as biomarker in prediction the prognosis of patients with acute pancreatitis. Methods: 54 cases with confirmed diagnosis of acute pancreatitis were included in the present work. Of the included 54 cases, 21 were mild acute pancreatitis and other 33 were server diseases. For the 33 severe cases, nine were finally dead and 24 were survived. The serological neopterin level of the 54 acute pancreatitis was continuously examined at the time point of days 0 (diagnosis), 1 (24 h after diagnosis), 2, 4, 8 and 14 by the enzyme linked immunosorbent assay (ELISA). The severity or death risk of the acute pancreatitis patients was predicted by the serological neopterin. Results: The serological neopterin was gradually increasing from days 0 to 8, but descending at day 14 in mild and survival groups. For days 8 and 14, the serological levels of neopterin in severe group were higher than those of mild group with statistical difference (p<0.05). The serum neopterin was statistical different in the time point of day 8 and day 14 between death and survival groups (p<0.05). For day 8, the serological neopterin as biomarker for death prediction sensitivity and specificity were 88.89% (95% CI: 51.75-99.72%) and 83.33% (95% CI: 62.62-95.26%) respectively with the AUC of 0.95 (95% CI: 0.88-1.00). For day 14, the death prediction sensitivity and specificity were 77.78% (33.99-97.19%) and 95.83% (78.88-99.89%) respectively with the AUC of 0.94 (95% CI: 0.87-1.00). Conclusions: Serological neopterin level was elevated with the development of the pancreatitis. Continuously monitoring the serum neopterin may helpful for prediction death risk of acute pancreatitis. In the later phase of disease beginning on day 8, neopterin levels may be used for risk assessment and possibly change of therapy regiment.