The Clinical Value of Procalcitonin in Early Assessment of Acute Pancreatitis

Abstract

OBJECTIVES:Early assessment of the severity and the etiology is crucial in the management of acute pancreatitis. To determine the value of procalcitonin (PCT) as a prognostic marker and as an indicator of biliary etiology in the early phase of acute pancreatitis. METHODS:In a prospective study, 75 consecutive patients were included (severe pancreatitis in 12 patients, biliary etiology in 42 cases). The value of PCT as a prognostic marker was compared to C-reactive protein (CRP), hematocrit (HCT), acute physiology and chronic health evaluation (APACHE) II score, and Ranson score. The value of PCT as an indicator of biliary etiology was compared to alanine aminotransferase (ALT) and alkaline phosphatase (AP). The area under the receiver operating characteristic curve (AUC) was applied as a measure of the overall accuracy of the single markers and multiple scoring systems. RESULTS:The most accurate prediction of severe disease was provided by the APACHE II score on the day of admission ( CONCLUSIONS: PCT is of limited additional value for early assessment of severity and etiology in acute pancreatitis. CRP is found to be a reliable prognostic marker with a delay of 48 h, while ALT is validated as the best indicator of biliary etiology.(Am J Gastroenterol 2005;100:1593-1597)

Practice Guidelines in Acute Pancreatitis

“…Several reports have indicated that gender has no prognostic significance (31,46,73,83,87,91,165). Furthermore, etiology has also been shown to have no prognostic significance (46,53,60,61,75,83,87,91,168) other than one report that indicated that patients with alcoholic pancreatitis in their first episode of pancreatitis have a greater need for intubation and greater prevalence of pancreatic necrosis (74).…”

“…In many (50, 55, 60, 67, 70, 75, 83, 86-88, 91, 128) but not all (31,46,53,61,165,168) reports, older age (generally ≥55 yr of age) has correlated with a more severe prognosis.…”

“…A variety of additional tests, including urinary trypsinogen activation peptide, serum trypsinogen-2, serum amyloid A, and calcitonin precursors, have shown promise at admission in distinguishing mild from severe pancreatitis in many (77)(78)(79)(80)159) but not all (165) reports. None of these tests is available commercially.…”

Prediction of acute pancreatitis severity via the combined analysis of inflammatory biomarkers and coagulation parameters

“…However, they did find a significant difference in CRP values between these two groups of patients and concluded that CRP was a better marker for assessment of the AP severity than PCT [14]. Different studies showed contradictory results, so the clinical significance of PCT in AP is still debatable [15,16,17]. In a multicentric study, Rau et al concluded that PCT did not allow prediction of pancreas infection; however, it was a reliable parameter for predicting clinically significant infected necrosis which would be complicated by MODS.…”

Procalcitonin Strip Test as an Independent Predictor in Acute Pancreatitis

“…Plasma PCT values were also found to correlate well with antibiotic requirement (Table 2) and was also found to be able to predict the progression to severe acute pancreatitis and organ failure (Table 3). A large number of studies have assessed the role of plasma PCT and compared it to other inflammatory markers in predicting the severity of pancreatitis and the development of infected necrosis [7][8][9][10][11][12][13][14]. These studies have shown that plasma procalcitonin is a good marker for predicting severity and development of organ failure in acute pancreatitis and as well as predicting the development of infected pancreatic necrosis.…”