B Cell Activating Factor of the Tumor Necrosis Factor Family (BAFF) Behaves as an Acute Phase Reactant in Acute Pancreatitis.docVIP

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B Cell Activating Factor of the Tumor Necrosis Factor Family (BAFF) Behaves as an Acute Phase Reactant in Acute Pancreatitis.doc

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B Cell Activating Factor of the Tumor Necrosis Factor Family (BAFF) Behaves as an Acute Phase Reactant in Acute Pancreatitis

BCellActivatingFactoroftheTumorNecrosisFactor Family(BAFF)BehavesasanAcutePhaseReactantin AcutePancreatitis GeorgPongratz1*,HannahHochrinner1,RainerH.Straub1,StefanieLang1,TanjaBru¨nnler1,2 1DepartmentofInternalMedicineI,UniversityHospitalRegensburg,Regensburg,Germany,2EmergencyCentre,HospitaloftheOrderofSt.JohnofGodRegensburg, Regensburg,Germany Abstract Objective:TodetermineifBcellactivatingfactorofthetumornecrosisfactorfamily(BAFF)actsasanacutephasereactant andpredictsseverityofacutepancreatitis. Methods:40patientswithacutepancreatitiswereincludedinthissinglecentercohortpilotstudy.Wholebloodandserum was analyzed on day of admission and nine consecutive days for BAFF, c-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin(PCT),andleucocytenumbers.DifferentseverityScores(Ranson,APACHEII,SAPSII,SAPSIII)andtheclinical courseofthepatient(treatment,durationofstay,durationICU)wererecorded. Results:SerumBAFFcorrelateswithCRP,anestablishedmarkerofseverityinacutepancreatitisatdayofadmissionwith a timecourse profil similar to IL-6 over the first nine days. Serum BAFF increases with Ranson score (Kruskal-Wallis: Chi2=10.8;p=0.03) similar toCRP(Kruskal-Wallis: Chi2=9.4;p=0.05). SerumBAFF, IL-6,andCRP levelsareelevatedin patients that need intensive care for more than seven days and in patients with complicated necrotizing pancreatitis. DiscriminantanalysisandreceiveroperatorcharacteristicsshowthatCRP(wilks-lambda=0.549;ROC:AUC0.948)andBAFF (wilks-lambda=0.907; ROC: AUC 0.843) serum levels at day of admission best predict severe necrotizing pancreatitis or death,outperformingIL-6,PCT,andnumberofleucocytes. Conclusion:ThisstudyestablishesforthefirsttimeBAFFasanacutephasereactantwithpredictivevalueforthecourseof acutepancreatitis.BAFFoutperformsestablishedmarkersinacutepancreatitis,likeIL-6andPCTunderscoringtheimportant roleofBAFFintheacuteinflammatoryresponse. Citation:PongratzG,HochrinnerH,StraubRH,LangS,Bru¨nnlerT(2013)BCellActivatingFactoroftheTumorNecrosisFact