Clinical Usefulness of the Serum Carboxypeptidase B Activation Peptide in Acute Pancreatitis

  • Raffaele Pezzilli Emergency Department, Sant'Orsola Hospital, University of Bologna. Bologna, Italy
  • Antonio Maria Morselli-Labate Department of Internal Medicine and Gastroenterology, Sant'Orsola Hospital, University of Bologna. Bologna, Italy
  • Anna Rita Barbieri Central Laboratory, Sant'Orsola Hospital, University of Bologna. Bologna, Italy
  • Livia Platè Central Laboratory, Sant'Orsola Hospital, University of Bologna. Bologna, Italy
Keywords: Amylases, C-Reactive Protein, Carboxypeptidases, Lipase, Pancreatitis, ROC Curve

Abstract

Objective To assess the sensitivity and specificity of the serum carboxypeptidase B activation peptide in diagnosing and determining the severity of acute pancreatitis. Patients Twenty consecutive patients with acute pancreatitis were studied on admission to the Emergency Room: 11 patients had mild pancreatitis, and 9 patients, severe pancreatitis. Twenty consecutive patients with non-pancreatic acute abdomen and 20 healthy subjects were also studied. Main outcome measures Serum carboxypeptidase B activation peptide was determined using radioimmunoassay. Results Nineteen of the 20 patients with acute pancreatitis (95.0%) had serum carboxypeptidase B activation peptide concentrations above the upper reference limit, whereas 1 of the 20 patients with non-pancreatic acute abdomen (5.0%) and none of the healthy subjects had serum levels of this protein above the upper reference limit. The serum carboxypeptidase B activation peptide concentrations of patients with severe acute pancreatitis were significantly higher than those of patients with mild acute pancreatitis on the 2nd (P=0.044) and 3rd days (P=0.028) of the study. The overall sensitivity and specificity of carboxypeptidase B activation peptide in assessing the severity of acute pancreatitis were 84.6% and 59.4%, respectively. Conclusions Serum carboxypeptidase B activation peptide may be used simultaneously both to diagnosis and assess the severity of acute pancreatitis on admission to the Emergency Room.

Image: Box and whisker plots of serum CAPAP, amylase, lipase and C-reactive protein.

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References

Neoptolemos JP, Carr-Locke DL, London NJ, Bailey IA, James D, Fossard DP. Controlled trial of urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones. Lancet 1988; 29:979-83.

Pezzilli R, Billi P, Barakat B, Baroncini D, D'Imperio N, Miglio F. Effects of early ductal decompression in human biliary acute pancreatitis. Pancreas 1998; 16:165-8.

Messori A, Rampazzo R, Scroccaro G, Olivato R, Bassi C, Falconi M, et al. Effectiveness of gabexate mesilate in acute pancreatitis. A metaanalysis. Dig Dis Sci 1995; 40:734-8.

Pederzoli P, Bassi C, Vesentini S, Campedelli A. A randomized multicenter clinical trial of antibiotic prophylaxis of septic complications in acute necrotizing pancreatitis with imipenem. Surg Gynecol Obstet 1993; 176:480-3.

McKay CJ, Curran F, Sharples C, Baxter JN, Imrie CW. Prospective placebo-controlled randomized trial of lexipafant in predicted severe acute pancreatitis. Br J Surg 1997; 84:1239-43.

Pezzilli R, Billi P, Miniero R, Fiocchi M, Cappelletti O, Morselli-Labate AM, et al. Serum interleukin-6, interleukin-8, and beta 2-microglobulin in early assessment of severity of acute pancreatitis. Comparison with serum C- reactive protein. Dig Dis Sci 1995; 40:2341-8.

Pezzilli R, Miniero R, Cappelletti O, Barakat B. Serum interleukin 6 in the prognosis of acute biliary pancreatitis. Ital J Gastroenterol Hepatol 1998; 30:291-4.

Appelros S, Thim L, Borgstrom A. Activation peptide of carboxypeptidase B in serum and urine in acute pancreatitis. Gut 1998; 42:97-102.

Bradley EL. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg 1993; 128:586-90.

CAPAP. Carboxypeptidase B activation peptide. Radioimmunoassay. Euro-Diagnostica AB, Malmö, Sweden. Doc. no. E-23-0027-01. February 1998.

Pezzilli R, Billi P, Barakat B, Miglio F. Lipase-amylase ratio does not determine the etiology of acute pancreatitis. Another myth bites the dust. J Clin Gastroenterol 1998; 26:34-8.

Siegel S. Non-parametric statistics for the behavioral sciences. McGraw-Hill, New York (NY). 1956.

Zweig MH, Campbell G. Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem 1993; 39:561-77.

Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982; 143:29-36.

Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristics curves derived from the same cases. Radiology 1983; 148:839-43.

Pezzilli R; Morselli-Labate AM; Miniero R; Barakat B; Fiocchi M; Cappelletti O. Simultaneous serum assays of lipase and interleukin-6 for early diagnosis and prognosis of acute pancreatitis. Clin Chem 1999; 45:1762-7.

Diem K, Lentner C. Documenta Geigy Scientific Tables. 7th ed. Basel: Ciba-Geigy, 1975: 85-98.

Tatsuoka MM. Multivariate analysis. John Wiley and Sons, New York. 1971.

Norusis MJ, SPSS Inc. SPSS/PC+ 4.0 Base, Statistics and Advanced Statistics Manuals for the IBM PC/XT/AT and PS/2. SPSS Inc., Chicago (IL). 1990.

Dervenis C, Johnson CD, Bassi C, Bradley E, Imrie CW, McMahon MJ, Modlin I. Diagnosis, objective assessment of severity and management of acute pancreatitis. Santorini Consensus Conference. Int J Pancreatol 1999; 25:195-210.

Borgstrom A, Appelros S. Activation peptides in acute pancreatitis. In: MW Buchler, W Uhl, H Friess, P Malfertheiner Eds. Acute pancreatitis. Novel concepts in biology and therapy. Blackwell Wissenschafts-Verlag, Berlin, 1999: 219-23.

Pezzilli R, Billi P, Miglioli M, Gullo L. Serum amylase and lipase concentrations, and lipase/amylase ratio, in the assessment of etiology and severity of acute pancreatitis. Dig Dis Sci 1993; 38:1265-9.

Ventrucci M, Pezzilli R, Naldoni P, Platè L, Baldoni F, Gullo L, Barbara L, Serum pancreatic enzyme behavior during the course of acute pancreatitis. Pancreas, 1987; 2:506-9.

Pezzilli R, Morselli-Labate AM, Barakat B, Fiocchi M, Cappelletti O. Is the association of serum lipase with beta2-microglobulin or C-reactive protein useful for establishing the diagnosis and prognosis of patients with acute pancreatitis? Clin Chem Lab Med 1998; 36:963-7.

Box and whisker plots
Published
2016-06-13
How to Cite
PezzilliR., Morselli-LabateA., BarbieriA., & PlatèL. (2016). Clinical Usefulness of the Serum Carboxypeptidase B Activation Peptide in Acute Pancreatitis. JOP. Journal of the Pancreas, 1(3), 58-68. https://doi.org/10.6092/1590-8577/373
Section
ORIGINAL ARTICLES