{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T23:36:22Z","timestamp":1793144182931,"version":"4.5.0"},"reference-count":49,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Early risk stratification in acute pancreatitis (AP) remains challenging, particularly for identifying patients who initially appear low-risk but later develop complications. The Modified Endothelial Activation and Stress Index (m-EASIX) reflects endothelial injury and systemic inflammation. This study evaluated the prognostic value of dynamic 48 h m-EASIX assessment for predicting adverse clinical outcomes in AP. Materials and Methods: This retrospective cohort study included adult patients hospitalized with AP between January 2020 and June 2025. Propensity score matching (1:1) was performed using age, sex, BISAP score and etiology. Laboratory parameters were recorded at admission and at 48 h. Adverse outcomes were defined as prolonged hospitalization (\u22658 days) and\/or pancreatic necrosis, abscess, intensive care unit admission or in-hospital mortality. Multivariable logistic regression was used to identify independent predictors of adverse outcomes. Receiver operating characteristic (ROC) analysis evaluated the predictive performance of m-EASIX and compared it with BISAP and Ranson scores. Results: A total of 258 patients were included in the initial cohort, of whom 93 experienced an adverse clinical course. After propensity score matching, 170 patients remained in the final analysis (85 per group). The 48 h m-EASIX score was independently associated with adverse outcomes in both unmatched and matched cohorts. ROC analysis showed a moderate discrimination for composite outcomes (AUC \u2248 0.76) and a stronger discrimination for hard outcomes (AUC up to 0.867). In all analyses, m-EASIX significantly outperformed BISAP and Ranson scores (DeLong test p &lt; 0.001). Dynamic risk reclassification showed that m-EASIX identified a subgroup of patients initially classified as low-risk by BISAP who later developed adverse outcomes. Conclusions: The dynamic assessment of m-EASIX at 48 h provides additional prognostic information for early risk stratification in AP and may help identify patients at an increased risk of unfavorable clinical courses.<\/jats:p>","DOI":"10.3390\/medicina62030568","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T11:14:14Z","timestamp":1773832454000},"page":"568","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Dynamic Assessment of Modified EASIX (m-EASIX) at 48 Hours Predicts Adverse Outcomes in Acute Pancreatitis: A Propensity Score-Matched Study"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0199-3791","authenticated-orcid":false,"given":"Hikmet","family":"\u00d6ztop","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Bursa Uludag University, Bursa 16059, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3952-522X","authenticated-orcid":false,"given":"Enes","family":"Yavuz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Bursa Uludag University, Bursa 16059, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nevriye G\u00fcl","family":"Ada Tak","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Bursa Uludag University, Bursa 16059, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2667-8963","authenticated-orcid":false,"given":"Fatih","family":"Eren","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Bursa Uludag University, Bursa 16059, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4991-9830","authenticated-orcid":false,"given":"Faz\u0131l \u00c7a\u011fr\u0131","family":"Hunutlu","sequence":"additional","affiliation":[{"name":"Division of Hematology, Department of Internal Medicine, University of Health Sciences, Bursa Sehir Training and Research Hospital, Bursa 16110, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1038\/s41392-025-02394-6","article-title":"Acute pancreatitis: Mechanisms and therapeutic approaches","volume":"11","author":"Hu","year":"2026","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1136\/gutjnl-2012-302779","article-title":"Classification of acute pancreatitis\u20142012: Revision of the Atlanta classification and definitions by international consensus","volume":"62","author":"Banks","year":"2013","journal-title":"Gut"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1136\/gutjnl-2017-314657","article-title":"Impact of characteristics of organ failure and infected necrosis on mortality in necrotising pancreatitis","volume":"68","author":"Schepers","year":"2019","journal-title":"Gut"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1016\/S0140-6736(20)31310-6","article-title":"Acute pancreatitis","volume":"396","author":"Boxhoorn","year":"2020","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"zrad008","DOI":"10.1093\/bjsopen\/zrad008","article-title":"PANC Study (Pancreatitis: A National Cohort Study): National cohort study examining the first 30 days from presentation of acute pancreatitis in the UK","volume":"7","author":"Kosti","year":"2023","journal-title":"BJS Open"},{"key":"ref_6","first-page":"443","article-title":"Objective early identification of severe acute pancreatitis","volume":"61","author":"Ranson","year":"1974","journal-title":"Am. J. Gastroenterol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1698","DOI":"10.1136\/gut.2008.152702","article-title":"The early prediction of mortality in acute pancreatitis: A large population-based study","volume":"57","author":"Wu","year":"2008","journal-title":"Gut"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1649","DOI":"10.1111\/jgh.13763","article-title":"BISAP, RANSON, lactate and others biomarkers in prediction of severe acute pancreatitis in a European cohort","volume":"32","year":"2017","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1053\/j.gastro.2012.03.005","article-title":"Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis","volume":"142","author":"Mounzer","year":"2012","journal-title":"Gastroenterology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.dld.2014.01.158","article-title":"Predictors of severe and critical acute pancreatitis: A systematic review","volume":"46","author":"Yang","year":"2014","journal-title":"Dig. Liver Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e147","DOI":"10.1097\/MPA.0000000000002602","article-title":"Updates From the 2025 IAP Acute Pancreatitis Guidelines","volume":"55","author":"Buxbaum","year":"2026","journal-title":"Pancreas"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"115576","DOI":"10.1016\/j.biopha.2023.115576","article-title":"Telomerase reverse transcriptase restores pancreatic microcirculation profiles and attenuates endothelial dysfunction by inhibiting mitochondrial superoxide production: A potential target for acute pancreatitis therapy","volume":"167","author":"Wang","year":"2023","journal-title":"Biomed. Pharmacother."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Dumnicka, P., Maduzia, D., Ceranowicz, P., Olszanecki, R., Dro\u017cd\u017c, R., and Ku\u015bnierz-Cabala, B. (2017). The interplay between inflammation, coagulation and endothelial injury in the early phase of acute pancreatitis: Clinical implications. Int. J. Mol. Sci., 18.","DOI":"10.3390\/ijms18020354"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1038\/s41409-020-01186-6","article-title":"Early bilirubinemia after allogeneic stem cell transplantation\u2014An endothelial complication","volume":"56","author":"Dai","year":"2021","journal-title":"Bone Marrow Transpl."},{"key":"ref_15","first-page":"187.e1","article-title":"Easix Score Correlates with Endothelial Dysfunction Biomarkers and Predicts Risk of Acute Graft-Versus-Host Disease After Allogeneic Transplantation","volume":"30","author":"Pedraza","year":"2024","journal-title":"Transpl. Cell. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3397","DOI":"10.1182\/bloodadvances.2020003885","article-title":"Modified EASIX predicts severe cytokine release syndrome and neurotoxicity after chimeric antigen receptor T cells","volume":"5","author":"Pennisi","year":"2021","journal-title":"Blood Adv."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"217","DOI":"10.3233\/CBM-220032","article-title":"Endothelial activation and stress index (EASIX) as a predictive biomarker in small cell lung cancer","volume":"35","author":"Kang","year":"2022","journal-title":"Cancer Biomark."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1007\/s00392-024-02534-y","article-title":"EASIX (endothelial activation and stress index) predicts mortality in patients with coronary artery disease","volume":"114","author":"Finke","year":"2025","journal-title":"Clin. Res. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Luft, T., Wendtner, C.M., Kosely, F., Radujkovic, A., Benner, A., Korell, F., Kihm, L., Bauer, M.F., Dreger, P., and Merle, U. (2021). EASIX for Prediction of Outcome in Hospitalized SARS-CoV-2 Infected Patients. Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.634416"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Park, S., Go, S.I., and Lee, G.W. (2022). The Endothelial Activation and Stress Index (EASIX) score is an independent prognostic factor in patients with diffuse large B-cell lymphoma. BMC Cancer, 22.","DOI":"10.1186\/s12885-022-09915-4"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Cavdar, V.C., Gokmen, Y., Aric, M., Altunkaya, T., Erdem, C.G., Gulturk, I., and Afsar, C.U. (2025). The Prognostic Value of the EASIX Score in Patients with Metastatic Pancreatic Cancer. Diagnostics, 15.","DOI":"10.3390\/diagnostics15141740"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Moreno-Casta\u00f1o, A.B., Fern\u00e1ndez, S., Brillembourg, H., Iraola, G., Moreno, D.F., Ventosa-Capell, H., Martinez-Sanchez, J., De Moner, B., Molina, P., and Ramos, A. (2026). m-EASIX (better than EASIX) predicts severe CAR T-cell toxicities, worse overall survival, and discriminates cytokine release syndrome from sepsis. Front. Immunol., 16.","DOI":"10.3389\/fimmu.2025.1664788"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.12669\/pjms.35.4.1286","article-title":"Accuracy of BISAP score in prediction of severe acute pancreatitis","volume":"35","author":"Arif","year":"2019","journal-title":"Pak. J. Med. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e15275","DOI":"10.1097\/MD.0000000000015275","article-title":"Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase","volume":"98","author":"Zhou","year":"2019","journal-title":"Medicine"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Salehi, A.M., Rezaei, R., Sadeghi, A., Ayubi, E., Hasanzarrini, M., Azandaryani, A.R., and Razzaghi, M. (2025). Diagnostic value of neutrophil\/lymphocyte ratio, platelet\/lymphocyte ratio and systemic immune-inflammation index for predicting the severity of acute pancreatitis. BMC Gastroenterol., 25.","DOI":"10.1186\/s12876-025-04370-4"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Wang, J., Chen, X., Qin, C., Zeng, X., Du, X., and Wang, D. (2024). The endothelial activation and stress index is a potential prognostic indicator for patients with acute pancreatitis managed in the intensive care unit: A retrospective study. Front. Med., 11.","DOI":"10.3389\/fmed.2024.1498148"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1172\/JCI64931","article-title":"IL-6 trans-signaling promotes pancreatitis-associated lung injury and lethality","volume":"123","author":"Zhang","year":"2013","journal-title":"J. Clin. Invest."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"O\u0142dakowska, M., \u015aciskalska, M., Kepinska, M., Marek, G., and Milnerowicz, H. (2022). Association of Genetic Variants in IL6 Gene (rs1800795) with the Concentration of Inflammatory Markers (IL-6, hs-CRP) and Superoxide Dismutase in the Blood of Patients with Acute Pancreatitis\u2014Preliminary Findings. Genes, 13.","DOI":"10.3390\/genes13020290"},{"key":"ref_29","first-page":"229","article-title":"Changes in cytokines and chemokines in an acute pancreatitis model","volume":"30","author":"Sevinc","year":"2024","journal-title":"Ulus. Travma Acil Cerrahi Derg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e1203","DOI":"10.1002\/iid3.1203","article-title":"The relationship between inflammatory cytokines and in-hospital complications of acute pancreatitis","volume":"12","author":"Yao","year":"2024","journal-title":"Immun. Inflamm. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1100\/tsw.2007.98","article-title":"TNF-\u03b1 as a therapeutic target in acute pancreatitis\u2014Lessons from experimental models","volume":"7","author":"Malleo","year":"2007","journal-title":"Sci. World J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1038\/mi.2016.101","article-title":"Immunopathogenesis of pancreatitis","volume":"10","author":"Watanabe","year":"2017","journal-title":"Mucosal Immunol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1152\/ajpgi.00271.2006","article-title":"Blockade of neurokinin-1 receptor attenuates CC and CXC chemokine production in experimental acute pancreatitis and associated lung injury","volume":"292","author":"Sun","year":"2007","journal-title":"Am. J. Physiol. Gastrointest. Liver Physiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1111\/j.1365-2362.1992.tb01826.x","article-title":"Interleukin-8 and neutrophil activation in acute pancreatitis","volume":"22","author":"Gross","year":"1992","journal-title":"Eur. J. Clin. Invest."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1159\/000114866","article-title":"Monocyte chemoattractant protein 1, active carboxypeptidase B and CAPAP at hospital admission are predictive markers for severe acute pancreatitis","volume":"8","author":"Appelros","year":"2008","journal-title":"Pancreatology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1007\/s00134-003-1668-4","article-title":"CC-chemokine activation in acute pancreatitis: Enhanced release of monocyte chemoattractant protein-1 in patients with local and systemic complications","volume":"29","author":"Rau","year":"2003","journal-title":"Intensive Care Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1097\/MEG.0b013e32835fd3f0","article-title":"C-reactive protein prognostic accuracy in acute pancreatitis: Timing of measurement and cutoff points","volume":"25","author":"Cardoso","year":"2013","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"273","DOI":"10.3109\/10408363.2015.1051659","article-title":"Laboratory markers predicting severity of acute pancreatitis","volume":"52","author":"Staubli","year":"2015","journal-title":"Crit. Rev. Clin. Lab. Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s13017-019-0247-0","article-title":"2019 WSES guidelines for the management of severe acute pancreatitis","volume":"14","author":"Tolonen","year":"2019","journal-title":"World J. Emerg. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1131235","DOI":"10.1155\/2022\/1131235","article-title":"Serum Lactate Dehydrogenase Is a Sensitive Predictor of Systemic Complications of Acute Pancreatitis","volume":"2022","author":"Huang","year":"2022","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.jcrc.2017.05.001","article-title":"Serum lactate dehydrogenase is predictive of persistent organ failure in acute pancreatitis","volume":"41","author":"Cui","year":"2017","journal-title":"J. Crit. Care"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"6657","DOI":"10.2147\/JIR.S339981","article-title":"Dynamic nomogram for predicting thrombocytopenia in adults with acute pancreatitis","volume":"14","author":"Deng","year":"2021","journal-title":"J. Inflamm. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"47","DOI":"10.2174\/138161211795049804","article-title":"Mean platelet volume: A link between thrombosis and inflammation?","volume":"17","author":"Gasparyan","year":"2011","journal-title":"Curr. Pharm. Des."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1186\/s13054-025-05590-6","article-title":"A prediction model for \u2018ICU mortality or prolonged ICU stay\u2019 in critically unwell patients with acute pancreatitis: Insights from a 2003\u20132020 cohort analysis using the ANZICS-CORE database","volume":"29","author":"Venkatesh","year":"2025","journal-title":"Crit. Care"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"22109","DOI":"10.1038\/s41598-023-48480-z","article-title":"Discharge protocol in acute pancreatitis: An international survey and cohort analysis","volume":"13","author":"Nagy","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1053\/j.gastro.2023.05.028","article-title":"Detailed Characteristics of Post-discharge Mortality in Acute Pancreatitis","volume":"165","author":"Farkas","year":"2023","journal-title":"Gastroenterology"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Acehan, F., Kalkan, C., Yilmaz, Y., Comoglu, M., Kayserili, F.M., Hayat, B., Enli, K., Altiparmak, E., and Ates, I. (2026). Early Predictors of Necrosis in Patients Presenting with Edematous Acute Pancreatitis: Prospective Validation of the Necrosis Development Score-48 (NDS-48). J. Hepato-Biliary-Pancreat. Sci., 1\u201312.","DOI":"10.1002\/jhbp.70057"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1038\/nrgastro.2010.114","article-title":"Etiology and diagnosis of acute biliary pancreatitis","volume":"7","author":"Bhagirath","year":"2010","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Ibrahim, M.Y., Alhaj, M.M., Ibrahim, A.A.A., Rabih, M., Rabih, M.R.M., Massaad, M.E.H., Elzubir, A.K., Abdelrahman, M.M.H., Abdelrahman, O.A.E., and Mohamed, S.O.O. (2025). Association of platelet-lymphocyte ratio with acute pancreatitis severity: Systematic review and meta-analysis. 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