Oleic acid chlorohydrin, a new early biomarker for the prediction of acute pancreatitis severity in humans

Abstract

BackgroundThe early prediction of the severity of acute pancreatitis still represents a challenge for clinicians. Experimental studies have revealed the generation of specific halogenated lipids, in particular oleic acid chlorohydrin, in the early stages of acute pancreatitis. We hypothesized that the levels of circulating oleic acid chlorohydrin might be a useful early prognostic biomarker in acute pancreatitis in humans.MethodsIn a prospective, multicenter cohort study, plasma samples collected within 24 h after presentation in the emergency room from 59 patients with acute pancreatitis and from 9 healthy subjects were assessed for oleic acid chlorohydrin levels.ResultsPancreatitis was mild in 30 patients, moderately severe in 16 and severe in 13. Oleic acid chlorohydrin levels within 24 h after presentation were significantly higher in patients that later progressed to moderate and severe acute pancreatitis. Using 7.49 nM as the cutoff point, oleic acid chlorohydrin distinguished mild from moderately severe-to-severe pancreatitis with high sensitivity/specificity (96.6/90.0%) and positive/negative predictive values (90.3/96.4%). Using 32.40 nM as the cutoff value sensitivity, specificity, positive and negative predictive values were all 100% for severe acute pancreatitis. It was found to be a better prognostic marker than BISAP score, hematocrit at 48 h, SIRS at admission, persistent SIRS or C-reactive protein at 48 h.ConclusionsOleic acid chlorohydrin concentration in plasma is elevated in patients with acute pancreatitis on admission and correlates with a high degree with the final severity of the disease, indicating that it has potential to serve as an early prognostic marker for acute pancreatitis severity.

Transition of care at discharge from the Intensive Care Unit: a scoping review

“…The medication review by a pharmacist before transferring the patient to the IU proved to be effective in reducing the number and severity of medications-related problems ( 49 ) , although the impact on outcomes such as mortality and readmission is inconclusive ( 14 , 49 ) . A recent study ( 61 ) found that medication reconciliation by a pharmacist reduced errors in medication transfer, potential adverse events, and related costs.…”

Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice

“…Franco-Pons et al [182] evaluated the generation of halogenated fatty acids in the areas of fat necrosis in rats and they concluded that during AP, adipose tissue release FA-CI, which exacerbated the SIRS. Based on these results, de-Madaria et al [183] evaluated the role of OAC in a prospective and multicenter cohort study as marker of the severity of AP. They concluded that OAC is generated during AP, its levels can be measured in plasma, and these correlate with AP severity.…”

Dietary Fat Patterns and Outcomes in Acute Pancreatitis in Spain

“…Only the chlorohydrin of oleic acid was present in plasma (10). In humans, we found that oleic acid chlorohydrin was an excellent early marker of moderate-tosevere disease (11).…”

“…Concerning the different types of UFAs, oleic acid is the more important MUFA, is the predominant fatty acid in human pancreatic extracts (23,32) and in human pancreatic necrotic collections (6,7). In vitro and laboratory animal studies suggest that oleic acid is associated with local and systemic toxicity (7,10,11,(33)(34)(35). In addition, in a study by Pironi et al in patients with parenteral nutrition, the administration of a lipid emulsion based on MUFA produces a higher inflammatory status than in patients using a fish-oil based lipid emulsion (36).…”

“…UFAs have been detected in pancreatic necrosis collections (6)(7)(8)(9). Furthermore, oleic acid chlorohydrin, a halogenated product derived from monounsaturated oleic acid, was recently described as a blood marker and mediator of complications in a rat model of AP (10) and in patients with AP (11). Thus, UFA-mediated toxicity seems to be a key pathway in determining complications of AP (11,12).…”