Plasma metabolomic analysis of patients with different severities acute pancreatitis

Acute pancreatitis (AP) is a prevalent gastrointestinal disease necessitating hospitalization globally, with an annual incidence ranging from 13 to 45 per 100,000 individuals [1] and a mortality rate of 5%-10%. [2]hile most cases follow a self-limiting course, approximately 20%-30% of cases progress to severe acute pancreatitis (SAP), characterized by pancreatic necrosis and multiorgan failure, with the mortality rate increasing to 36%-50%. [2][3][4][5][6] Early and precise severity assessment is essential for guiding individualized therapeutic interventions to improve outcomes in critical cases and for optimizing resource allocation for mild patients.Despite the wide acceptance of several scoring systems such as Accuracy of Acute Physiology and Chronic Health Evaluation (APACHE) II, Ranson, and Computed Tomography Severity Index (CTSI), their clinical efficacy is constrained by inadequate prediction accuracy, sensitivity, and specificity. [7]Therefore, the identification of potential biomarkers for AP severity is urgently needed.Metabolomics, defined as "the quantitative analysis of dynamic metabolic responses to pathophysiological stimuli or genetic modifications in biological systems", [8] has attracted major interest in medical research during the past decade. [9]However, only a limited number of metabolomics studies have focused on pancreatitis.Furthermore, these previous studies emphasized the differences between patients and healthy controls rather than those between severe and mild cases, and were limited to small sample sizes or rely on animal models. [9]n this study, liquid chromatography-mass spectrometry (LC-MS) was used to analyse the plasma metabolism of patients with AP of varing severities, with the aim of identifying potential metabolites for assessing the severity of AP.This study was approved by the Ethics Committee of the First Affiliated Hospital of Soochow University.Written information was provided, and informed consent was obtained from all the subjects.All patients and healthy volunteers were informed before their plasma samples were collected.The diagnosis of moderate and severe acute pancreatitis (MAP/SAP) followed the revised Atlanta classification. [1]The exclusion criteria for patients were as follows: (1) presence of cardiovascular, cerebrovascular, liver, kidney or hematopoietic system diseases or other comorbidities; (2) diagnosis of diabetes, hyperthyroidism, hypothyroidism or other metabolic disorders; (3) had a history of alcohol or drug abuse; (4) long-term use of specific medications (such as antibiotics, hormones, etc.); (5) occurrence of major life events (such as psychological trauma, extensive burns, etc.) within the prior two weeks; and (6) lactation or pregnancy.From August 2022 to February 2023, 87 patients diagnosed with AP in the Intensive Care Unit, Emergency Department or Gastroenterology Department of the First Affiliated Hospital of Soochow University were selected.Of the participants, 48 patients had MAP (21 males, 27 females; mean age 53 15 years), while 39 patients had SAP (23 males, 16 females; mean age 46 16 years).Furthermore, 30 age-matched healthy volunteers were chosen as controls (16 males, 14 females; mean age 47 13 years).Peripheral blood samples were collected within 24