Biomarkers in Acute Pancreatitis: Integrating Current Evidence with Pathophysiology and Clinical Practice.

Acute pancreatitis (AP) is an inflammatory disorder of the pancreas with clinical manifestations that range from mild, self-limited disease to severe necrotizing inflammation complicated by organ failure and significant mortality. Accurate early assessment of disease severity remains challenging, as clinical presentation at admission often does not reflect the underlying inflammatory burden or risk of progression. Biomarkers have therefore gained increasing importance as objective tools that support diagnosis, severity stratification, and prediction of complications in AP. Traditional enzymatic markers, including serum amylase and lipase, are widely used for diagnostic confirmation but show limited value in predicting outcomes. In contrast, biomarkers reflecting systemic inflammation, immune activation, and infection provide more meaningful prognostic information. These include acute-phase reactants, cytokines, and infection-associated markers such as procalcitonin. In recent years, advances in molecular and omics-based technologies have led to the identification of novel biomarkers, including pentraxin-3, microRNAs, and proteomic and metabolomic signatures, which offer earlier insight into disease progression and pathophysiological mechanisms. This review synthesizes current evidence on established and emerging biomarkers of AP, evaluates their clinical relevance and limitations, and discusses future perspectives for integrated biomarker-based approaches aimed at improving early risk assessment and individualized patient management.