Functional protein C levels during the early phase of clinical acute pancreatitis

Objective: Protein C modulates microvascular thrombosis in sepsis, with levels being depleted in severe cases. Similar changes occur in necrotizing acute pancreatitis (AP). However, little is known of the pathophysiological characteristics of endogenous protein C early in the disease course of AP. This study undertakes an evaluation of protein C levels in AP. Methods: In a consecutive series of 57 patients with AP, the chromogenic substrate method was used to determine functional protein C levels in plasma. Protein C activity and variables required for the calculation of Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were assessed at admission and 24 and 48 hours after admission. Results: The median functional protein C level was 97 U/dL (range, 41-178 U/dL) on admission and 96 U/dL (range, 46-170 U/dL) 24 hours after admission. There was no significant difference in the functional protein C levels between the patients with an admission APACHE score of 8 or higher and those with lower APACHE II scores. Linear regression plots showed a nonsignificant trend to the lower levels of functional protein C activity in those patients with higher APACHE II scores. Conclusions: In human AP, functional protein C levels are conserved in mild disease. However, there is evidence that levels are depleted early in severe disease, suggesting a parallel between the pathophysiology of severe sepsis and that of severe AP. Copyright © 2010 by Lippincott Williams & Wilkins.