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
ARTICLE HIGHLIGHTS
Research background

Acute cholangitis is potentially lethal when accompanied by sepsis because of biliary obstruction. It is necessary to identify predictive biomarkers for patients who require emergent biliary drainage and patients who maybe progress to systemic bloodstream infection at an early stage of the disease.

Research motivation

Bacteremia induces hyperactive immune response and mitochondrial dysfunction. Presepsin is responsible for pathogen recognition by innate immunity. Acylcarnitines are established mitochondrial biomarkers. However, it is unknown whether presepsin or specific acylcarnitine species can reflect the severity of acute cholangitis and the timing of biliary drainage.

Research objectives

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

Research methods

In this prospective observational study, 280 patients with acute cholangitis were included from May 2019 to July 2021. The severity was stratified as mild, moderate, and severe according to 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. Patients were followed-up for 28 d.

Research 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 AUC of a combination of presepsin, direct bilirubin, alanine aminotransferase, temperature, and butyryl-L-carnitine for predicting biliary drainage was 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 and acetyl-L-carnitine.

Research conclusions

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

Research perspectives

Prospective observational study reports the predictive value of presepsin and acylcarnitines for severity and biliary drainage of acute cholangitis. Future research should focus on the association between acylcarnitines and the changes of intestinal microflora and bacterial translocation in acute cholangitis.