Angiopoietin-2 as a predictor of fluid sequestration in acute pancreatitis

Introduction: Angiopoietin-2 (Ang-2) is a vascular mediator associated with increased endothelial permeability. It has been described that Ang-2 levels are associated with severity of acute pancreatitis (AP). We hypothesize that Ang-2 may be associated with fluid sequestration (FS), thus it may be an early marker of increased fluid requirements. Aims: Our main aim was to investigate the association between serum Ang-2 levels and FS. Our secondary aimwas to investigate the relationship between serum Ang-2 levels and outcome. Patients & methods: Retrospective analysis of a prospective clinical database and banked serum (obtained in the first 24h of admission) of consecutive patients admitted with AP. Ang-2 levels were measured by enzyme-linked immunosorbent assay. FS was categorized according to percentiles of FS (water balance) in Group A: p75 (>3.8L). Results: We included 123 episodes of AP, 52.8% females, 63.4% gallstone AP. Median (p25-p75) Ang-levels (pg/mL) were 3752 (2486-4384) in group A, 4685 (3459-6057) in group B and 4928 (3071-6119) in group C, p < 0.05. Ang-2 levels (pg/mL) were significantly (p<0.05) associated with pancreatic necrosis [Ang-2 levels 5031 (4374-11261) vs 4531 (3071-5886)], persistent organ failure [8083 (5027-16132) vs 4387 (3075-5884) and severity according to the Atlanta classification [5031 (4024-8085) vs 4531 (3074-5922)]. Conclusion: Early serum Ang-2 levels are associated with fluid sequestration and outcome of acute pancreatitis.