The procalcitonin test in the evaluation of clinical severity in patients with acute pancreatitis

Purpose

To determine the role of the procalcitonin test in the clinical and laboratory evaluation of the clinical severity and the intensity of the systemic inflammatory reaction in patients with different forms of acute pancreatitis.

Design

A prospective study.

Patients

The study covered 50 patients with acute pancreatitis of various aetiologies. Patients were subdivided into five groups depending on morphological and microbiological criteria: (1) 10 patients with acute interstitial pancreatitis (AIP); (2) 16 non-operated patients with limited sterile pancreatic necrosis (LSN-N); (3) six operated patients with limited necrosis (LSN-O); (4) six patients with extensive sterile necrosis (ESN); (5) 12 patients with infected forms of pancreatic necrosis (IPN).

Methods

Plasma procalcitonin (PCT) concentrations were determined using an immunoluminometric method. The clinical severity of the patients' condition was evaluated with the help of the integral APACHE II scale. Laboratory and instrumental techniques of investigation were supplemented by calculations of the leucocyte intoxication index.

Results

The mean PCT concentration in infected forms of destructive pancreatitis was markedly higher than in acute interstitial pancreatitis or sterile pancreatic necrosis, at a level of 2.95 ± 0.84 ng/ml. The PCT concentration rose as the patient's condition became more severe, and as it evolved from an interstitial form to infected pancreatic necrosis. A direct correlation was established between the PCT concentration and the APACHE II score (r = 0.56). A PCT concentration > 2 ng/ml is a threshold level indicating infection of pancreatic tissue.

Conclusions

The procalcitonin test is an objective criterion in the complex evaluation of clinical severity in patients with acute pancreatitis. Monitoring of the PCT concentration assists in the early diagnosis of infective complications of acute pancreatitis, and allows surgical and intensive-care treatment strategies to be optimised in these patients.