B cell activating factor of the tumor necrosis factor family (BAFF) behaves as an acute phase reactant in acute pancreatitis.

To determine if B cell activating factor of the tumor necrosis factor family (BAFF) acts as an acute phase reactant and predicts severity of acute pancreatitis.40 patients with acute pancreatitis were included in this single center cohort pilot study. Whole blood and serum was analyzed on day of admission and nine consecutive days for BAFF, c-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT), and leucocyte numbers. Different severity Scores (Ranson, APACHE II, SAPS II, SAPS III) and the clinical course of the patient (treatment, duration of stay, duration ICU) were recorded.Serum BAFF correlates with CRP, an established marker of severity in acute pancreatitis at day of admission with 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 to CRP (Kruskal-Wallis: Chi2 = 9.4; p = 0.05 ). Serum BAFF, IL-6, and CRP levels are elevated in patients that need intensive care for more than seven days and in patients with complicated necrotizing pancreatitis. Discriminant analysis and receiver operator characteristics show that CRP (wilks-lambda = 0.549; ROC: AUC 0.948) and BAFF (wilks-lambda = 0.907; ROC: AUC 0.843) serum levels at day of admission best predict severe necrotizing pancreatitis or death, outperforming IL-6, PCT, and number of leucocytes.This study establishes for the first time BAFF as an acute phase reactant with predictive value for the course of acute pancreatitis. BAFF outperforms established markers in acute pancreatitis, like IL-6 and PCT underscoring the important role of BAFF in the acute inflammatory response

Time course of serum BAFF, CRP, IL-6, and leucocyte counts after stratification of patients in edematous, necrotizing, and severe necrotizing pancreatitis or death.

<p>Serum levels of BAFF (pg/ml, A), CRP (mg/l, B), IL-6 (pg/ml, C), and leucocyte counts (/nl, D) after stratification of patients into cases with edematous pancreatitis (EP, open circles), necrotizing pancreatitis (NP, solid circles), and severe necrotizing pancreatitis or death (sNPoD, solid triangles). Differences between groups (BAFF: p<0.001; CRP: p<0.001; IL-6: p<0.001; Leucocyte count: p<0.001) were determined by general linear modeling and Student-Newman-Keuls method. P-values represent differences as compared to EP (* p<0.05, ** p<0.01, *** p<0.001). Error bars respresent the S.E.M.</p

Relationship of BAFF, CRP, and PCT serum levels, and Ranson score.

<p>(A) Scatter plot for serum BAFF (pg/ml) and CRP (mg/l). Correlation coefficient was determined by Spearman procedure. Linear regression line (solid line), 95% confidence interval (dashed lines). (B) Different median values of serum BAFF (pg/ml, solid lines) at different categories of Ranson Score. Each dot represents value of one patient at day of admission. An overall significant difference between the groups was determined by Kruskal-Wallis statistic (Chi² = 10.8; p = 0.03). (C) Different median values of CRP (solid lines) at different categories of Ranson Score. Each dot represents value of one patient at day of admission. An overall significant difference between the groups was determined by Kruskal-Wallis statistic (Chi² = 9.4; p = 0.05). (D) Different median values of PCT (solid lines) at different categories of Ranson Score. Each dot represents value of one patient at day of admission. An overall significant difference between the groups was determined by Kruskal-Wallis statistic (Chi² = 15.5; p = 0.004).</p

Time course of serum BAFF, CRP, IL-6, and leucocyte counts after stratification of patients according to the duration of intensive care.

<p>Serum levels of BAFF (pg/ml, A), CRP (mg/l, B), IL-6 (pg/ml, C), and leucocyte counts (/nl, D) after stratification of patients into cases needing more than one week or less or equal to one week of intensive care. Differences between groups (BAFF: p<0.001; CRP: p<0.001; IL-6: p = 0.001; Leucocyte count: p<0.001) were determined by general linear modeling and Student-Newman-Keuls method (* p<0.05, ** p<0.01, *** p<0.001). Error bars respresent the S.E.M.</p

Patient characteristics.

<p>Patient characteristics.</p