Role of the protein C system in aggravation of acute pancreatitis

The goal of the study was to identify risk factors for coagulation and fibrinolysis in aggravation of acute pancreatitis (AP) based on 11 markers and APACHE-II score.
The subjects were 42 patients with AP (12 severe AP and 30 mild AP) and 20 healthy controls. Measurements of antithrombin III (AT-III), plasminogen (Plg), platelet counts, lipopolysaccaride (LPS), thrombomodulin (TM), protein C (PC), activated protein C (APC), APC/PC ratio, free-protein S (f-PS), thrombin-antithrombin complex (TAT), and tissue-type plasminogen activator·PAI-1 (t-pA·PAI-1) complex and clinical scores were performed using ELISA kits and clinical examinations of patients.
Fluctuations of most markers in the course of AP indicated abnormal activation from onset to 3 days. After 7 days, non-survivor severe AP (SAP) cases showed abnormal marker reactivation, while survivor SAP and mild AP (MAP) cases had gradual normalization of markers. At 7 days after onset and during all stages of progression of AP, there were significant differences between non-survivor SAP and survivor SAP cases for 5 and 8 markers, respectively, but APC and t-pA·PAI-1 complex were common to both. The TAT/APC and t-pA·PAI-1/APC ratios, which reflect APC generation, were higher in survivor SAP than in non-survivor SAP cases. A decrease in APC generation leading to excessive thrombin synthesis may be a risk factor for coagulation and fibrinolysis in aggravation of AP.