Carboxypeptidase-B activation peptide, a marker of pancreatic acinar injury, but not L-selectin, a marker of neutrophil activation, predicts severity of acute pancreatitis.

Background: Severity prediction is difficult early in the course of acute pancreatitis. Markers of pancreatic injury, or inflammatory activation are candidate markers of severity. The aim of the present study was to assess predictive abilities of carboxypeptidase-B activation peptide (CAPAP-B) and soluble L-selectin (sL-selectin) using samples collected on admission to hospital.

Methods: Patients with acute pancreatitis and disease (acute abdomen) and normal controls were studied. Samples were collected at admission and daily for 5 days. There were significant differences between mild and severe pancreatitis in urinary and plasma CAPAP-B on admission, C-reactive protein on day 3 and acute physiology and chronic health evaluation (APACHE)-II scores. Prediction of severity with CAPAP-B on admission was as good as with APACHE-II score after 48 h. Carboxypeptidase-B activation peptide was not raised in disease controls. By contrast, sL-selectin was lowered in all cases of acute pancreatitis, and in disease controls. There was no difference between mild and severe pancreatitis.

Conclusion: Urinary CAPAP-B, a marker of acinar injury, can be used to predict severity of acute pancreatitis at the time of admission to hospital, but sL-selectin has no value in this regard. The extent of acinar injury may be a more important early marker of severity than markers of inflammatory activation.