Acute Pancreatitis Patients With Elevated Unbound Fatty Acids At Admission Have Worse Outcomes

Background: Elevated serum unsaturated non-esterified fatty acids (NEFA) are associated with severe pancreatitis However, most NEFA are carried bound to albumin, which along with calcium can reduce their toxicity We have recently shown unbound fatty acids (uFA) mediate cell injury and are associated with worse lung injury during COVID-19 infection We therefore investigated the prognostic value of serum uFA in patients admitted with acute pancreatitis Methods: Patients presenting to theMayo Clinic Arizona\u0027s emergency department with acute pancreatitis were included Admission serum was analyzed and patients were followed during their hospitalization for severity, and length of stay (LOS) Parameters studied included age, sex, bodymass index, LOS, serum calcium, albumin and uFA Normal values of uFA were determined based on outpatient controls Results: The study consisted of 86AP patients, and 56 controls (uFA = 0 4-4 8 μM) 9 AP patients developed persistent organ failure (POF) Patients with mild AP had lower uFA (3 5 ± 2 4 μM) vs those with severe AP (12 9 ± 18 5 μM, P \u003c 0 005) and a shorter LOS 3 2 ± 2 8 days (vs 15 7 ± 10 9 days, P \u003c 0 005) A cut off uFA ≥4 9 μMwas associated with a longer LOS (8 8 ± 9 6 days vs 3 3 ± 2 8 days, P \u003c 0 04), and increased risk of POF (odds ratio, 11 47;95% CI, 2 19-60 2;P \u003c 0 004) Mild AP patients had higher calcium (9 6 ± 0 5 mg/dl vs 8 6 ± 1 3 mg/dl, P \u003c 0 005) and albumin (4 4 ± 0 5 g/dl vs 3 6 ± 1 1 g/dl, P \u003c 0 005) levels Other factors including lipase, amylase, BMI, and age were not significantly different between mild and severe AP patients There was no association between Serum uFAvs serum Calcium or albumin Conclusions: Patients with high unbound fatty acids on admission have a higher risk of POF, and longer length of hospital stay The prognostic value of these in relation to other risk factors for severe AP remains to be determined