Molecular mechanisms and biochemical markers of acute pancreatitis

Abstract

Despite recent advances in research on etiopathogenesis of acute pancreatitis (AP), not all factors that determine the onset and course of the disease have been explained. Researchers concentrate on investigating the factors conditioning the development of severe AP. They consider genetic predisposition, the type of possible responsible factors, and comorbidities. The most essential task, however, remains to be the assessment of sensitivity and specificity of biochemical and serological markers in diagnosis and prognosis of developing severe AP and their clinical availability. Serum lipase is a more reliable diagnostic marker of AP than serum amylase. Trypsinogen activation peptide (TAP) ensures early diagnosis of AP. Useful predictors of severity may include serum procalcitonin and urinary TAP, serum interleukins-6 and -8 and polymorphonuclear elastase at 24 h, and serum C-reactive protein (CRP) at 48h. Researchers concentrate on searching for the best possible prognostic factor of AP. In clinical practice, though diagnosis is based on biological markers, clinical assessment and other laboratory results included in Ranson scale or APACHE II and imaging investigations used to define computer tomography severity index (CTSI). Accurate prognosis of AP course cannot be made until all those parameters have been determined so that the best possible treatment can be undertaken.