Comparison of Interleukin-6, C-Reactive Protein, Procalcitonin, and the Computed Tomography Severity Index for Early Prediction of Severity of Acute Pancreatitis

Abstract

Background/Aims: Acute pancreatitis (AP) is a common gastrointestinal disease associated with hospitalization. With the increase in its incidence, AP has become a greater burden on healthcare resources. Early identification of patients with mild AP can facilitate the appropriate use of resources. We aimed to investigate the ability of inflammatory markers, including interleukin-6 (IL-6), procalcitonin, and C-reactive protein (CRP), as well as various scoring systems to differentiate mild AP from more severe diseases. Methods:We retrospectively investigated patients hospitalized with AP, for whom severity assessment and clinical course confirmation were possible. Inflammatory markers were measured at admission, and CRP levels were measured 24 hours after admission (CRP2). Predictive values were calculated using the area under the receiver operating characteristic curve (AUROC) and logistic regression model analysis. Results:Of 103 patients with AP, 42 (40.8%) were diagnosed with mild AP according to the revised Atlanta classification. Based on the AUROC, IL-6 (0.755, p<0.001), CRP2 (0.787, p<0.001), and computed tomography severity index (CTSI) (0.851, p<0.001) were useful predictors of mild AP. With standard cutoff values, the diagnostic sensitivity, specificity, and accuracy were 83.3%, 62.3%, and 70.9% for IL-6 (<50 pg/mL), and 78.6%, 63.9%, and 69.9% for CRP2 (<50 mg/L), respectively. The AUROC of IL-6 and CRP2 were significantly higher than those of other inflammatory markers and were not significantly different from that of CTSI.Conclusions: IL-6, CRP2, and CTSI are helpful for early differentiation of AP severity. Among inflammatory markers, IL-6 has the advantage of early prediction of mild pancreatitis at the time of admission.

Overview of Pediatric Procalcitonin Testing Patterns in a Tertiary Care Children’s Hospital

“…Finally, many tested children presented with symptoms or a diagnosis for which evidence is either lacking or does not support PCT (eg, GI or skin complaints). 14-17 These findings suggest a great deal of inappropriate use of PCT testing both by service type and disease category.…”

“…PCT has not been shown to be beneficial in the diagnosis of any of these disease processes, and testing perhaps could have been avoided in these patients. [14][15][16][17] Overall, about one-third of the PCT values were elevated, onethird were negative, and one-third were indeterminant for skin, GI, and musculoskeletal presentations, suggesting there is probably not much utility in testing. While these patients could have presented with other symptoms triggering more appropriate use of PCT, it is unlikely that was true for all of them, and this may be an area in which education of providers could be beneficial at avoiding inappropriate use of the test.…”

“…Bone/ joint/SSTI and GI infections were considered to be inappropriate for PCT testing, since data do not support use for patients with those diagnoses. [14][15][16][17] The chart review was performed by one pediatric hospitalist (SS). Data were analyzed to describe the means and proportions of tests ordered by service.…”

“…Bone/joint/SSTI and GI infections were considered to be inappropriate for PCT testing, since data do not support use for patients with those diagnoses. 14-17…”

The relationship between inflammatory cytokines and in‐hospital complications of acute pancreatitis

“…Excessive TNF‐α enters the blood circulation, and stimulates the production of cytokines (IL‐1β, IL‐6, IL‐8), causing a “waterfall‐like cascade reaction,” leading to a cytokine storm. The correlation between disease severity and cytokine levels of IL‐1β, IL‐6, IL‐8, and IL‐10 has been repeatedly confirmed, but the sensitivity and specificity reported in different literature vary greatly 21–23 . Sternby et al 24 performed paired comparisons of samples collected at 0–24 and 25–48 h after AP onset, and the results showed that IL‐1β, IL‐6, IL‐8, and IL‐10 changed over time, and there were significant differences between different severity groups after 24 h. Ćeranić et al 25 monitored the serum concentrations of IL‐6, IL‐8, and IL‐10 at the admission of AP patients, and compared with IL‐8 and IL‐10, IL‐6 had the highest predictive value for SAP at admission, which is consistent with our study.…”