Elevation of circulating cell free DNA in patients with acute pancreatitis is associated to disease markers and prolonged hospitalization time

Early identification of patients with severe biliary pancreatitis is critical for reduction of morbidity and mortality. There are several complex classifications scores currently used to stratify patients, all are cumbersome, long to evaluate and limited. Circulating cell free DNA (cfDNA) levels rise in severe diseases such as malignancy, sepsis, head injuries etc. The aim of this study was to evaluate the predictive value of cfDNA measured by our fast fluorometric method in patients suffering from biliary pancreatitis.

In a cohort prospective study we have recruited 80 patients with mean age of 58 years. Serum cfDNA levels were measured by our direct SYBR-Gold fluorometric assay at admission, and every day, for 4 consecutive days.

Patients were categorized according standard composite pancreatitis scores. According to RANSON`s score, 54 patients had "mild pancreatitis" and 24 patients had a "severe disease". According to APACHE II score, 58 patients had "mild disease" and 21 patients had "severe pancreatitis". For both scores cfDNA were elevated in patients with "severe disease" (p<0.01 and p<0.05). Levels of admission cfDNA and cfDNA at 24 hours were in strong correlation with blood levels of alkaline phosphatase, total and direct bilirubin, known to increase by bile duct blockade, which characterize biliary pancreatitis. Hospitalization time of patients defined with "severe pancreatitis" according to RANSON or APACHE II was not longer than patients with "mild disease". In contrast, patients with elevated cfDNA at 24 hours (>850 ng/ml) were hospitalized for a longer period than patients with normal levels of cfDNA [median (range), 7 days (3-26) vs 4 days (2-15), (p<0.001)]with AUC of 0.731for ROC curve.

To conclude, cfDNA levels correlated with severity of pancreatitis defined by two known severity scores. Moreover, in contrast to these complex scores elevated cfDNA levels were predictive of long hospitalization time. Our data suggest that fast cfDNA measurements by our simple method could be used as effective prognostic tool for biliary pancreatitis patients.