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Chemerin: a new biomarker to predict postendoscopic retrograde cholangiopancreatography pancreatitis

Koksal, Ali R.; Boga, Salih; Alkim, Huseyin; Sen, Ilker; Neijmann, Sebnem T.; Alkim, Canan

European Journal of Gastroenterology & Hepatology: June 2016 - Volume 28 - Issue 6 - p 714–721
doi: 10.1097/MEG.0000000000000597
Original Articles: Pancreatic Disorders

Introduction Individuals with increased visceral adiposity are considered to be more sensitive and more prone to severe acute pancreatitis because of the inflammatory microenvironment they have. We hypothesized that insulin resistance, adipokines, and proinflammatory cytokines that markedly affect the course of pancreatitis can contribute toward development of postendoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis (PEP) and aimed to investigate the association between PEP risk and preprocedural serum vaspin, chemerin, tumor necrosis factor α, interleukin-6 (IL-6) levels, and homeostasis model assessment of insulin resistance.

Patients and methods Eighty-two patients with a diagnosis of choledocholithiasis and 30 controls were enrolled. Preprocedural chemerin, vaspin, IL-6, and well-known PEP risk factors were compared between PEP and non-PEP groups.

Results The mean age of the patients was 56.3±14.4 years; 52 patients were women. Adipocytokine levels, BMIs, and waist circumferences of the patient group were found to be higher than those of the controls. Total cannulation success and the mean procedure time were 82.9% and 28.7±8.8 min, respectively. PEP developed in 12 (14.6%) patients. Chemerin levels in the PEP group were higher than those in the non-PEP group (580.2±172.5 vs. 392.2±168.2 ng/ml, P<0.01). Insulin resistance was higher in the PEP group than the non-PEP group (P=0.001), but there was no significant difference between PEP and non-PEP groups in terms of preprocedural vaspin, tumor necrosis factor α, IL-6, and C-reactive protein levels. According to logistic regression analysis, increased chemerin levels, homeostasis model assessment of insulin resistance 2.5 or greater, and pancreatic duct cannulation were found to be independent risk factors for PEP [odds ratio (OR)=1.006, P=0.006; OR=4.57, P=0.05; OR=6.54, P=0.02].

Conclusion Elevated serum chemerin levels and insulin resistance are independent risk factors of PEP development.

aDepartment of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital

bDepartment of Biochemistry, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey

Correspondence to Ali R. Koksal, MD, Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, Halaskargazi Av. Etfal St., 34371 Sisli, Istanbul, Turkey Tel: +90 212 373 5169; fax: +90 212 224 0772; e-mail:

Received November 12, 2015

Accepted January 11, 2016

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.