Procalcitonin Strip Test as an Independent Predictor in Acute Pancreatitis

Abstract

Plasma procalcitonin (PCT) is a highly specific marker for the diagnosis of bacterial infection and sepsis. Studies have demonstrated its role in the setting of sepsis and acute pancreatitis. This study aims to analyze and compare the prognostic efficacy of plasma procalcitonin strip test in acute pancreatitis. A prospective study was conducted in the department of general surgery from June 2012 to June 2013. Plasma procalcitonin was estimated by the semiquantitative strip test. The study included a total of 50 patients diagnosed to have acute pancreatitis. Data was collected and statistically analyzed using SPSS version 17. Thirty-nine out of the 50 patients (78 %) were males with a mean age of 46.8 years (range, 25-78 years) and 25 patients (50 %) had ethanol-induced pancreatitis, while 13 patients (26 %) had gall stone pancreatitis. Plasma PCT values were found to correlate better than CRP levels and total leukocyte count with the total duration of hospitalization, ITU, and ICU stay, as well as with the progression to severe acute pancreatitis. A cut off for plasma PCT of >2 ng/mL was found to be 100 % sensitive and 100 % specific and a cut off for CRP of >19 mg/dL was 70 % sensitive and 65 % specific for predicting the progression to severe acute pancreatitis. Plasma PCT also correlated well with antibiotic requirement. A cut off value of >0.5 ng/mL for plasma PCT was 100 % sensitive and 80 % specific and a cut off value of >18 mg/dL for CRP was 86 % sensitive and 63 % specific for predicting antibiotic requirement. Plasma procalcitonin is an early and reliable prognostic indicator in acute pancreatitis. The procalcitonin strip test is a rapid test which is useful in analyzing prognosis in patients with acute pancreatitis.

Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice

“…Severe AP is known to be associated with sepsis, infected pancreatic necrosis, and multiorgan failure, and PCT can be used as an early tool in the prognosis of AP [130,131]. For a faster result, PCT levels can be measured by a semiquantitative strip test with a cut-off level of 0.5 ng/mL [132] while other studies report a better cut-off of 2 ng/mL [133]. An increased PCT level in patients with AP was found to be indicative of severity, pancreatic necrosis, and organ failure.…”

Comparative evaluation of various scoring systems to predict prognosis in patients with acute biliary pancreatitis

“…In a study of 75 patients -of which 12 had severe acute pancreatitis-while investigating the predictive power of procalcitonin levels on severe acute pancreatitis, it was found that procalcitonin levels on admission and at 48 th hour had limited predictive power on biliary pancreatitis and severe pancreatitis (26). However, in another study on 50 patients, the predictive power of procalcitonin levels determined by strip test for duration of hospitalization, the need for intensive care, the necessity of antibiotic therapy, and the development of severe acute pancreatitis was examined, and it was found that procalcitonin levels showed higher correlation than CRP and leukocyte levels (15). In the present study, cut-off value of NLR at 48 th hour for predicting the severity of pancreatitis was 7.48, and its predictive power was shown to be at a level consistent with other studies in the literature.…”

“…The distribution of prognostic scores according to the revised Atlanta classification is presented in Table 5. The values of 15 mg/dL and 0.5 ng/mL for CRP and procalcitonin were used in reference to previous publications in the literature (10,15). There are different cut-off values in the literature for NLR (14).…”

“…In a recent publication, in addition to these scores, it was demonstrated that albumin-bilirubin (ALBI) grading, a useful score of evaluate liver function and a grading system used in hepatocellular cancer, may also be prognostically significant (13). In addition to prognostic scores, there are comparative studies showing that acute phase indicators such as neutrophil lymphocyte ratio (NLR), C-reactive protein (CRP), and procalcitonin levels can also predict severe acute pancreatitis, pancreatic necrosis, organ failure, and mortality (14,15).…”

“…Although cut-off values are different, advanced age is integrated as a factor in Ranson, Glasgow-Imrie, JSS, BISAP, and APACHE scoring systems.It has been demonstrated that moderate or severe pancreatitis according to the revised Atlanta classification is associated with a longer duration of In patients with moderate and severe pancreatitis, inflammatory markers such as NLR, procalcitonin, and CRP are elevated. Inflammatory markers are often studied as a standalone indicator, but they are also integrated into scoring systems such as JSS(6,10,15).…”