The Value Of Serum SIRT1 Levels In Early Acute Pancreatitis

Background/aimsAcute pancreatitis(AP),especially severe acute pancreatitis(SAP),is one of the most common critical diseases of the digestive system with rapid development and high mortality.In order to get AP patients received timely and effective treatment,it is particularly important for clinicians to evaluate patients' condition in the early stage of this disease.Silencing information regulator(SIRT)is highly conserved nicotinamide adenine dinucleotide-dependent protein deacetylases in cells.Seven kinds of SIRT have been found in mammals,named SIRT1-7,respectively.SIRT1 have shown to play an important role in anti-inflammatory response,and the purpose of this study was to explore the value of serum SIRT1 protein levels in early AP.Methods1.Participants: Healthy control(HC)and AP patients who visited the First Affiliated Hospital of Nanchang University from August 2016 to September 2018 were included in this observational study.2.Determination of serum SIRT1 protein levels: The whole blood samples of the subjects were collected and centrifuged for 10 minutes at 3000 rpm/min.The upper serum was taken and frozen in a refrigerator at-20?.Serum SIRT1 and interleukin-6(IL-6)levels were determined by enzyme-linked immunosorbent sorbent assay(ELISA),and compared them with clinical indicators.3.Statistical methods: The data were statistically analyzed in SPSS 23.0 software.Quantitative data are reported as the mean ± SEM or mean(95% confidence intervals),and the statistical significance was verified by analysis of variance.Nominal data were showed as numbers(percentage of the group)and were analyzed by Pearson's chi-square test or Fisher's exact test.Results1.General data:A total of 37 health controls(HC)and 113 AP patients within 48 hours of onset were included in the study.Of 113 patients,29 were mild AP(MAP),40 moderately severe AP(MSAP)and 44 SAP.2.Comparison of serum SIRT1 protein levels: Serum SIRT1 levels were measured in 37 HC and 113 patients.The serum SIRT1 protein levels were 1495.7±185.9,2098.3±153.6,2498.4±198.2,and 3674.3±170.8 pg/ml in the HC,MAP,MSAP,and SAP group,respectively.Obvious differences were observed between HC and patients with AP(P<0.05).The serum SIRT1 concentration was positively correlated with the severity of AP(r = 0.535,P < 0.05).Besides,the serum SIRT1 levels in patients with persistent organ failure(POF)were significantly higher than that in patients with non-POF(3674.3±170.8 pg/ml VS.2330.2±138.1 pg/ml,P < 0.05).3.Comparison of serum IL-6 levels: A total of 20 HC,14 MAP,22 MSAP and 22 SAP were measured.The serum IL-6 levels in each group were 3.2±1.2,29.4±7.7,67.9±13.4 and 147.5±19.4 pg/ml,respectively.There were significant differences among the 4 groups(P<0.05).Furthermore,the serum SIRT1 levels were positively correlated with the serum IL-6 levels(r = 0.375,P < 0.05).4.Value of the serum SIRT1 levels in predicting POF: When the cut-off of the SIRT1 concentration was 4065.4 pg/ml,the serum SIRT1 concentration had an area under the curve(AUC)of the receiver operating characteristic curve of 0.825(95% CI: 0.744-0.906)for predicting POF,with a sensitivity of 61.4% and specificity of 92.8%.The AUC of the serum SIRT1 levels in predicting POF was lower than that of acute physiology-chronic health score(APACHE II score),bedside index for severity in acute pancreatitis(BISAP score)and serum procalcitonin levels,but slightly higher than serum C-reactive protein and IL-6.5.Value of combining serum SIRT1 levels with BISAP score: When serum SIRT1 levels combined with BISAP score,the predicted AUC value of POF will rise to 0.931(95% CI: 0.882,0.980).In addition,united AUC value for predicting ICU transfer,necrotizing pancreatitis and death are 0.888(95%CI: 0.824,0.953),0.804(95%CI: 0.716,0.892)and 0.918(95%CI: 0.860,0.976),respectively.Conclusions1.The anti-inflammatory factors represented by SIRT1 and pro-inflammatory factors represented by IL-6 were significantly increased in the serum of AP patients,which was related to the severity of AP.2.High serum SIRT1 protein levels may serve as an early predictive serum marker for POF.3.Combining the serum SIRT1 levels with BISAP increased the ability to predict POF.4.Combining the serum SIRT1 levels with BISAP has great value in predicting ICU transfer,necrotizing pancreatitis and death.