Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2023; 29(16): 2502-2514
Published online Apr 28, 2023. doi: 10.3748/wjg.v29.i16.2502
Predictive value of presepsin and acylcarnitines for severity and biliary drainage in acute cholangitis
Han-Yu Zhang, Hong-Li Xiao, Guo-Xing Wang, Zhao-Qing Lu, Miao-Rong Xie, Chun-Sheng Li
Han-Yu Zhang, Hong-Li Xiao, Guo-Xing Wang, Zhao-Qing Lu, Miao-Rong Xie, Chun-Sheng Li, Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Author contributions: Li CS and Xie MR contributed to the study conception and design; Zhang HY, Xiao HL, Wang GX, Lu ZQ participated in the material preparation and data collection. Zhang HY, Xiao HL and Wang GX performed the analyses. Xiao HL drafted the initial manuscript and revised the article; all authors read and approved the final manuscript; Zhang HY, Xiao HL and Wang GX contributed equally and share first authorship.
Supported by National Natural Science Foundation of China, No. 81773931; Beijing Municipal Administration of Hospitals’ Youth Program, No. QML20170105; and Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support ‘‘Yangfan’’ Project, No. ZYLX201804.
Institutional review board statement: The study was reviewed and approved by the Beijing Friendship Hospital Ethics Committee (Approval No.2018-P2-063-01).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chun-Sheng Li, PhD, Professor, Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing 100050, China. lcscyyy@163.com
Received: January 9, 2023
Peer-review started: January 9, 2023
First decision: February 15, 2023
Revised: February 21, 2023
Accepted: March 31, 2023
Article in press: March 31, 2023
Published online: April 28, 2023
Processing time: 105 Days and 3.3 Hours
Abstract
BACKGROUND

Bacteremia, which is a major cause of mortality in patients with acute cholangitis, induces hyperactive immune response and mitochondrial dysfunction. Presepsin is responsible for pathogen recognition by innate immunity. Acylcarnitines are established mitochondrial biomarkers.

AIM

To clarify the early predictive value of presepsin and acylcarnitines as biomarkers of severity of acute cholangitis and the need for biliary drainage.

METHODS

Of 280 patients with acute cholangitis were included and the severity was stratified according to the Tokyo Guidelines 2018. Blood presepsin and plasma acylcarnitines were tested at enrollment by chemiluminescent enzyme immunoassay and ultra-high-performance liquid chromatography-mass spectrometry, respectively.

RESULTS

The concentrations of presepsin, procalcitonin, short- and medium-chain acylcarnitines increased, while long-chain acylcarnitines decreased with the severity of acute cholangitis. The areas under the receiver operating characteristic curves (AUC) of presepsin for diagnosing moderate/severe and severe cholangitis (0.823 and 0.801, respectively) were greater than those of conventional markers. The combination of presepsin, direct bilirubin, alanine aminotransferase, temperature, and butyryl-L-carnitine showed good predictive ability for biliary drainage (AUC: 0.723). Presepsin, procalcitonin, acetyl-L-carnitine, hydroxydodecenoyl-L-carnitine, and temperature were independent predictors of bloodstream infection. After adjusting for severity classification, acetyl-L-carnitine was the only acylcarnitine independently associated with 28-d mortality (hazard ratio 14.396; P < 0.001) (AUC: 0.880). Presepsin concentration showed positive correlation with direct bilirubin or acetyl-L-carnitine.

CONCLUSION

Presepsin could serve as a specific biomarker to predict the severity of acute cholangitis and need for biliary drainage. Acetyl-L-carnitine is a potential prognostic factor for patients with acute cholangitis. Innate immune response was associated with mitochondrial metabolic dysfunction in acute cholangitis.

Keywords: Acute cholangitis; Severity; Biliary drainage; Presepsin; Acylcarnitines

Core Tip: Acute cholangitis leads to sepsis and organ dysfunction because of biliary obstruction. Identification of predictive biomarkers for patients who require emergent biliary drainage and patients who may progress to systemic bloodstream infection at an early stage of the disease is a key imperative. Our study suggests that presepsin and acetyl-L-carnitine may serve as biomarkers to predict the severity of acute cholangitis and the need for biliary drainage. Innate immune response was associated with mitochondrial metabolic dysfunction.