C-reactive protein prognostic accuracy in acute pancreatitis

Cardoso, Filipe S.; Ricardo, Leonel; Oliveira, Ana Maria; Canena, Jorge; Horta, David; Papoila, Ana Luísa

doi:10.1097/meg.0b013e32835fd3f0

Cited by 79 publications

(59 citation statements)

References 19 publications

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“…However, CRP levels are infl uenced by liver disease ( 11 ), which may be present in many patients with AP who are obese and/or alcoholics. Furthermore, CRP levels peak at 72-96 h aft er symptom onset, which can limit its prognostic accuracy as patients typically present at variable times aft er symptom onset ( 12,13 ). Finally, CRP is a laboratory marker that is not routinely measured in AP patients throughout the world.…”

mentioning

confidence: 99%

Admission Hematocrit and Rise in Blood Urea Nitrogen at 24 h Outperform other Laboratory Markers in Predicting Persistent Organ Failure and Pancreatic Necrosis in Acute Pancreatitis: A Post Hoc Analysis of Three Large Prospective Databases

Koutroumpakis

Bakker

et al. 2015

American Journal of Gastroenterology

133

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mentioning

confidence: 99%

Admission Hematocrit and Rise in Blood Urea Nitrogen at 24 h Outperform other Laboratory Markers in Predicting Persistent Organ Failure and Pancreatic Necrosis in Acute Pancreatitis: A Post Hoc Analysis of Three Large Prospective Databases

Koutroumpakis

Bakker

et al. 2015

American Journal of Gastroenterology

133

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“…Further, the importance of CRP lies in its value for predicting the healing of acute pancreatic inflammation as follow-up CRP levels will correctly reveal which patients will develop complications or which will heal uneventfully (7). As shown in the present article, we believe that combining serum CRP level measurements taken at 48 h and later will improve the Ranson scoring system for having a higher accuracy for the differentiation of the mild and severe forms of AP.…”

mentioning

confidence: 64%

“…Another important point with CRP is that although it is one of the earliest acute-phase reactants that increases , Ülkü Sarıtaş in level, CRP level higher than 170 mg/dL at 48 hours has been reported to be more valuable for predicting severe acute pancreatitis and pancreatic necrosis than CRP level measurements at any time before 48 hours (7). Further, the importance of CRP lies in its value for predicting the healing of acute pancreatic inflammation as follow-up CRP levels will correctly reveal which patients will develop complications or which will heal uneventfully (7).…”

mentioning

confidence: 99%

C-Reactive Protein Levels Together with the Ranson Scoring System to Differentiate the Mild and Severe Forms of Acute Pancreatitis

Üstündağ

Sarıtaş²

2017

Turk J Gastroenterol

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It is important to differentiate the mild and severe forms of acute pancreatitis (AP) at the earliest with a high level of accuracy to decrease the morbidity and mortality rates of AP. For this, there are various scoring methods based on clinical and laboratory parameters together with radiological data specifically obtained via contrastenhanced computed tomography (CT). There are several commonly used prognostic scoring systems for AP such as Ranson, Glasgow, APACHE II (acute physiology and chronic health status), and BISAP (bedside index for severity in AP). Like the rest of them, the Ranson criteria still holds their value and can fail in the differentiation of mild forms of AP from severe ones. We still need to have cheap, easily applicable, and widely available tests to differentiate the mild and severe forms of AP as early as possible with a high accuracy.One of the first acute-phase reactants rising in level in our body during every kind of inflammation and/or infection is the C-reactive protein (CRP). This test is one of the widely available, non-invasive, and easily applicable tests that is a highly valuable prognostic indicator in patients with AP. After the 1980s, there have been many reports published in the literature underlying role of CRP for determining the severity of AP with or without the help of the Ranson scoring system (1). The present article (2) reminds us that the potential value of CRP and that the results of this paper are important as these results can stimulate most physicians worldwide dealing with AP to routinely use this marker. Although the level of CRP has been shown by many reports to determine the severity of AP, the cutoff level of CRP to differentiate the mild and severe forms have been reported to significantly vary. Moreover, rather than using CRP levels with scoring methods to improve their prognostic value, there are many reports in the literature that aimed to compare CRP levels with these scoring methods (3-5). One of these reports indicated that CRP levels are valuable for determining the degree of necrosis as early as possible with a similar sensitivity and specificity to the other scoring methods (5).The cutoff level for CRP was considered as 150 mg/dL in the present article (2), and this level was used in other reports including Vinish et al. (6); this level was found to correlate very well with other scores, including BISAP, HAPS, and SIRS results. Additionally, CRP levels higher than 150 mg/dL have been reported to indicate the presence of pancreatic necrosis and peri-pancreatic fluid accumulation as shown in CT images taken 72 h after the onset of AP (6). In the present article, the authors compared four groups of patients with AP according to Ranson score and CRP levels to differentiate the mild and severe forms of AP: 1: Group 1: Ranson score≥3, Group 2: CRP level≥150 mg/L, Group 3: Ranson score≥3 and CRP level≥150 mg/L, and Group 4: Ranson score≥3 or CRP level≥150 mg/dL. The authors concluded that patients in group 3 had the highest accuracy (92%) among those...

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“…On the other hand, CRP is not specific for AP, and other causes of inflammation must be considered, especially when it comes to acute cholangitis and AP overlapping in gallstone disease [37]. Although CRP overall has a high specificity and sensitivity, its increase can be delayed, resulting in reduced predictive strength very early after the onset of symptoms [38]. Repeated measurements are recommended.…”

Section: Risk Stratification In Apmentioning

confidence: 99%

Risk Stratification and Early Conservative Treatment of Acute Pancreatitis

2019

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Background: Acute pancreatitis (AP) is a potentially life-threatening common gastrointestinal disorder with increasing incidence around the globe. Although the majority of cases will take an uneventful, mild course, a fraction of patients is at risk of moderately severe or severe pancreatitis which is burdened with substantial morbidity and mortality. Early identification of patients at risk of a severe disease course and an adopted treatment strategy are crucial to avoid adverse outcomes. Summary: In this review we summarize the most recent concepts of severity grading in patients diagnosed with AP by adopting recommendations of current guidelines and discussing them in the context of the available literature. The severity of AP depends on the presence of local and/or systemic complications and organ failure. To predict the severity early in the disease course, host-specific factors (age, comorbidities, body mass index), clinical risk factors (biochemical and physiological parameters and scoring systems), as well as the response to initial therapy need to be considered and revisited in the short term. Depending on the individual risk and comorbidity the initial treatment can be guided, which will be discussed in the second part of this review. Key Message: Predicting the severity of AP and adapting the individual treatment strategy requires multidimensional risk assessment and close observation during the early phase of AP development.

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C-reactive protein prognostic accuracy in acute pancreatitis

Abstract: CRP at 48 h after hospital admission showed a good prognostic accuracy for SAP, PNec, and IM, better than CRP measured at any other timing. The optimal CRP at 48 h after hospital admission cutoff points for SAP, PNec, and IM varied from 170 to 190 mg/l.

Cited by 79 publications

References 19 publications

Admission Hematocrit and Rise in Blood Urea Nitrogen at 24 h Outperform other Laboratory Markers in Predicting Persistent Organ Failure and Pancreatic Necrosis in Acute Pancreatitis: A Post Hoc Analysis of Three Large Prospective Databases

Admission Hematocrit and Rise in Blood Urea Nitrogen at 24 h Outperform other Laboratory Markers in Predicting Persistent Organ Failure and Pancreatic Necrosis in Acute Pancreatitis: A Post Hoc Analysis of Three Large Prospective Databases

C-Reactive Protein Levels Together with the Ranson Scoring System to Differentiate the Mild and Severe Forms of Acute Pancreatitis

Risk Stratification and Early Conservative Treatment of Acute Pancreatitis

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