Angiopoietin-2 Is an Early Indicator of Acute Pancreatic-Renal Syndrome in Patients with Acute Pancreatitis

Abstract

Within the first week of the disease, acute kidney injury (AKI) is among the most common causes of mortality in acute pancreatitis (AP). Recently, serum angiopoietin-2 (Ang-2) has been associated with hyperdynamic state of the systemic circulation. The aim of this study was to examine the associations between Ang-2 and the clinical AP severity during the first 72 hours of the disease, and organ disfunction, including AKI. Methods. Study included patients admitted to the surgery ward, diagnosed with AP. AKI was diagnosed according to KDIGO guidelines and renal failure according to modified Marshall scoring system. Ang-2 was determined in serum with ELISA. Results. AP was classified as mild (MAP) in 71% of patients, moderately severe (MSAP) in 22%, and severe (SAP) in 8%. During the first 72 hours of AP, 11 patients developed AKI and 6 developed renal failure. Ang-2 at 24, 48, and 72 hours following the onset of AP symptoms significantly predicted SAP and MSAP, as well as AKI and renal failure. Also, Ang-2 significantly correlated with acute phase proteins as well as with the indicators of renal disfunction. Conclusions. Serum Ang-2 may be a relevant predictor of AP severity, in particular of the development of AP-renal syndrome.

Serum Soluble Fms-Like Tyrosine Kinase 1 (sFlt-1) Predicts the Severity of Acute Pancreatitis

“…In our study, sFlt-1 positively correlated with Ang-2 (although the correlation is of moderate strength), and as we have previously shown for Ang-2 [10], it was also significantly positively correlated with the markers of kidney function (including creatinine, urea, cystatin C, uACR, uNGAL and sNGAL) and predicted kidney failure. sFlt-1 has been shown to contribute in endothelial dysfunction to chronic kidney disease [37] and to correlate with mortality in patients on maintenance hemodialysis [38].…”

“…Angiopoietin-2 (Ang-2), associated with endothelial dysfunction and vascular leakage in acute states [7], has been recently proposed as a marker of severity in AP [8,9,10]. Other markers of endothelial activation and dysfunction were shown to be increased in severe AP, including soluble E-selectin, tissue factor or von Willebrand factor and endothelial-specific microRNAs [5,11,12,13].…”

Urinary Extracellular Vesicles: Potential Biomarkers of Renal Function in Diabetic Patients

“…In the milder stage of renal failure we may expect the higher number of EVs in urine, as the primary marker of the renal dysfunction. In further study the more specific attention should be focused on the correlation between cystatin C and even angiopoietin 2, which appeared to be a relevant predictor of renal dysfunction in acute pancreatitis patients [38]. Age is the strongest factor influencing physiological state, as well as renal function.…”

Circulating Angiopoietin-2 and Its Soluble Receptor Tie-2 Concentrations Are Related to Renal Function in Two Population-Based Cohorts

“…Ang-2 is supposed to reflect the amount of endothelial activation [32] and to predict the severity and outcome in critically ill patients or of illnesses like acute pancreatitis [32], CKD [15], or after cardiac surgery [33], in early stages of the medical conditions. These predictions were often linked to an deterioration of renal function [15, 32, 33].…”

“…These predictions were often linked to an deterioration of renal function [15, 32, 33]. Taking into account the differences in the present study between serum creatinine/eGFR(crea) and serum cystatin C/eGFR(cys) and the assumption that serum cystatin C or the eGFR(cys) are more sensitive and earlier markers of renal dysfunction or damage [16, 26, 34], one possible conclusion might be that serum cystatin C concentrations, eGFR(cys) and serum Ang-2 concentrations might be reacting sooner towards renal impairment with potential endothelial activation than serum creatinine concentrations.…”