The Predicting Value Of Plasma Trefoil Factor-2 For Acute Gastrointestinal Injury In Patients With Acute Pancreatitis

Objective: Acute gastrointestinal injury(AGI)is commonly present in patients with acute pancreatitis(AP).It is often difficult to predict gastrointestinal function in the early stage due to lack of reliable markers.We aimed to assess whether early plasma trefoil factor-2(TFF-2)is a potential predictor for AGI and severity of AP.Methods: The prospective observational study of AP patients who had been admission to the Emergency ICU and Surgery ICU of Ruijin hospital,a tertiary university hospital affiliated to Shanghai Jiao Tong University School of Medicine,from January 2013 to December 2015.72 patients were included for the onset of AP within 72 hours and plasma samples were collected at admission.30 samples of healthy adults were also collected as control.The TFF-2 levels were assessed by using a human TFF-2 enzyme-linked immunoassay.Through comparing TFF-2 plasma concentration of AP patients,tried to analyze the correlation of TFF-2 and AGI,TFF-2 and severity of AP,and then found a determined diagnostic cut-off for gastrointestinal dysfunction.Results: Early plasma TFF-2 levels among AP patients were significantly higher than healthy controls(991.60 ng/ml vs.94.37ng/ml,P<0.0001).TFF-2 levels had a significant correlation with AGI Grades from 1st to 7th day after admission(r=0.399,0.451,0.445,0.428,0.442,0.309,0.304 respectively,P<0.05).TFF-2 levels were apparently increased when patients with intra-abdominal hypertension,or absent bowel sounds,or bowel dilatation,or feeding intolerance syndrome,or with three and more gastrointestinalsymptoms in one day.As a predictor of gastrointestinal dysfunction,plasma TFF-2 was superior to others: APACHE-II,SOFA,procalcitonin,C-reactive protein,serum calcium(area under the receiver operating characteristic curve(AUC)=0.809,cut-off 946.85ng/ml,sensitivity 0.645,specificity 0.833).In addition,TFF-2 increased along with the severity of AP(r=0.55,P<0.0001)and associated with hospital stays and ICU stays.Conclusions: Early plasma TFF-2 levels are increased in AP patients and correlated positively with AGI grades and disease severity.TFF-2 might be a potential predictor both for AGI and severity of AP.