Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] · 2026
Serum GAS6 is useful biomarker for identifying patients with severe acute pancreatitis within 24 h of admission: a multi-cohort analysis of 869 patients.
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Zhang Xiuli, Peng Kaixin, Peng Yunpeng, Lu Jiongdi, Deng Hanzhang, Li Bin, Lu Zipeng, Cao Feng, Li Qiang, Wen Li
Аннотация
OBJECTIVES: Early identification of severe acute pancreatitis (SAP) within 24 h of admission remains challenging and specific biomarkers reflecting the underlying mechanisms, particularly pancreatic necrosis, are lacking. We have previously identified a crucial role of AXL and MERTK in regulating pancreatic necrosis. Their ligands, Growth Arrest-Specific 6 (GAS6) and Protein S (PROS1) can be detected in serum. Therefore, this study aims to evaluate the value of serum GAS6 and PROS1 levels within 24 h of admission for identifying SAP.
METHODS: Serum GAS6 and PROS1 were initially assessed in a retrospective discovery cohort and subsequently validated in a prospective cohort using ELISA. A subset of patients provided serial serum samples over 4 weeks to analyze temporal dynamics and correlations with disease severity.
RESULTS: A total of 869 AP patients were enrolled. Serum GAS6 levels were significantly elevated and PROS1 levels reduced compared with healthy controls, with greater changes in moderately severe and severe cases. As a single marker, GAS6 showed robust performance for predicting SAP (AUC = 0.722, 95%CI: 0.620-0.832), outperforming CRP (AUC = 0.595) and BUN (AUC = 0.681), and comparable to SIRS (AUC = 0.659), BISAP (AUC = 0.755), and APACHE-II (AUC = 0.797). The GAS6+BISAP combination yielded an AUC of 0.818, significantly superior to GAS6 alone (p = 0.001), SIRS (p = 0.013), CRP (p = 0.002), and BUN (p = 0.015), and numerically higher than APACHE-II (0.818 vs. 0.797). The temporal dynamic changes of both further correlated with disease severity.
CONCLUSIONS: Serum levels of GAS6 measured within 24 h provide a valuable, rapid approach for identifying SAP, and when combined with established scoring systems, can further improve performance.
METHODS: Serum GAS6 and PROS1 were initially assessed in a retrospective discovery cohort and subsequently validated in a prospective cohort using ELISA. A subset of patients provided serial serum samples over 4 weeks to analyze temporal dynamics and correlations with disease severity.
RESULTS: A total of 869 AP patients were enrolled. Serum GAS6 levels were significantly elevated and PROS1 levels reduced compared with healthy controls, with greater changes in moderately severe and severe cases. As a single marker, GAS6 showed robust performance for predicting SAP (AUC = 0.722, 95%CI: 0.620-0.832), outperforming CRP (AUC = 0.595) and BUN (AUC = 0.681), and comparable to SIRS (AUC = 0.659), BISAP (AUC = 0.755), and APACHE-II (AUC = 0.797). The GAS6+BISAP combination yielded an AUC of 0.818, significantly superior to GAS6 alone (p = 0.001), SIRS (p = 0.013), CRP (p = 0.002), and BUN (p = 0.015), and numerically higher than APACHE-II (0.818 vs. 0.797). The temporal dynamic changes of both further correlated with disease severity.
CONCLUSIONS: Serum levels of GAS6 measured within 24 h provide a valuable, rapid approach for identifying SAP, and when combined with established scoring systems, can further improve performance.