Background: The potential to predict pancreatic necrosis within the first 48 h by using plasma soluble thrombomodulin (sTM) in 104 patients with acute pancreatitis (AP) was analyzed in a prospective 5-year investigation performed at a single institution.

Methods: According to Balthazar CT grade, pancreatitis was classified as no necrosis in 72 patients, one-third necrotic in 18 patients, one-half necrotic in 10 patients and more than one-half necrotic in 4 patients. Blood was collected at the first 48 hours after the onset of pain and analyzed for sTM.

Results: In the healthy volunteers, plasma levels of TM were 16.49±5.24 μg/L. By comparison, the mean plasma levels of TM in each group of pancreatitis patients were as follows: CT grade A group, 34.21±10.73 μg/L; CT grade B group, 36.18±12.50 μg/L; CT grade C group, 49.39±18.38 μg/L; CT grade D group, 114.46±39.44 μg/L; CT grade E group, 100.22±15.97 μg/L (p< 0.01). And for the patients, the Pearson correlation coefficient between the CT grade and TM values was 0.784 (p< 0.01). No necrosis group, 39.22±13.75 μg/L; one-third necrotic group, 71.44±18.02 μg/L; one-half necrotic group, 123.50±28.57 μg/L; more than one-half necrotic group, 129.00±33.28 μg/L (p< 0.01); And for the patients, the Pearson correlation coefficient between the degree of necrosis and TM values was 0.888 (p< 0.01). ROC analysis indicated the area under the ROC curve (AUC±SE) for sTM was 0.949±0.020, clearly supportive of the high accuracy of this index in predicting the necrosis of AP.

Conclusion: Plasma soluble thrombomodulin (sTM) is a potential marker to predict pancreatic necrosis within the first 48 h, and further investigation in a multicentre study is necessary.