Adipokines as biomarkers in paediatric acute pancreatitis: a prospective exploratory single-centre observational study

BACKGROUND Adipokines are involved in inflammatory response, including pathogenesis of acute pancreatitis (AP). Studies in adults suggest their potential role as biomarkers of AP severity and clinical course. OBJECTIVE To evaluate the utility of adiponectin, resistin, visfatin, and fibroblast growth factor-21 (FGF-21) as biomarkers in paediatric AP, with regard to disease severity and nutritional status. MATERIALS AND METHODS This prospective observational exploratory study included children with AP hospitalised between 2020 and 2024 and normal-weight controls with functional abdominal pain. Adipokine concentrations were compared between groups and according to nutritional status, and disease severity. Receiver operating characteristic analysis and univariate logistic regression were performed to evaluate the discriminatory performance and associations of adipokines and conventional inflammatory markers. RESULTS The study included 57 children diagnosed with AP and 33 controls; 18 patients with AP were overweight or obese. AP was classified as mild in 46 patients, moderately severe in 10, and severe in 1 child. No statistically significant differences in adipokine concentrations between children with AP and controls, as well as between AP patients with overweight or obesity and normal body weight remained after correction for multiple comparisons. Moderate-to-severe AP was associated with higher visfatin concentration after 72 h (0.48 vs 0.28 ng/mL) and higher conventional inflammatory markers. Visfatin after 72 h demonstrated moderate discriminatory performance for identifying moderate-to-severe AP (AUC = 0.752, 95% CI: 0.612-0.893; p < 0.001). In logistic regression, only conventional inflammatory markers predicted AP severity. CONCLUSION Although selected adipokines were associated with inflammatory and metabolic alterations in paediatric AP, none demonstrated superior discriminatory performance compared with conventional inflammatory markers.