Objective: Endothelial dysfunction contributes to the severity of acute pancreatitis (AP), but the prognostic utility of endothelial biomarkers and their association with therapeutic interventions remain poorly defined. This study aimed to determine whether endothelial dysfunction biomarkers predict clinical deterioration in AP and whether plasmapheresis is associated with changes in these biomarkers and clinical outcomes.
Materials and Methods: In this prospective cohort study of 100 patients with AP, serial endothelial biomarkers, including vascular endothelial growth factor (VEGF), von Willebrand factor (vWF), endothelin-1 (ET-1), and soluble E-selectin (sE-selectin), were measured on admission and on days 3 and 7. All patients received conventional therapy, and 68 additionally received adjunctive plasmapheresis through nonrandomized assignment. The conventional therapy cohort (n=32) was stratified into Worsened (n=17) and Improved (n=15) subgroups according to clinical course to establish prognostic biomarker cutoffs.
Results: Endothelial marker levels at admission predicted subsequent clinical deterioration (p<0.001). Biomarker trajectories differed significantly between the Improved and Worsened subgroups. Patients who received plasmapheresis exhibited more favorable biomarker profiles, with levels resembling those of the Improved subgroup by day 7. This biomarker pattern was associated with a lower rate of the composite clinical deterioration endpoint than that observed in the Worsened subgroup (12% vs. 100%, p<0.001).
Conclusion: Endothelial dysfunction biomarkers are early predictors of the clinical course of AP. Plasmapheresis was associated with favorable biomarker trajectories and improved clinical outcomes, suggesting that endothelial dysfunction may be a potential therapeutic target warranting investigation in randomized trials.