Increased procalcitonin serum levels as predictive parameter of multiple organ failure and outcome in acute pancreatitis patients

Introduction

A high serum level of procalcitonin (PCT), an inflammatory mediator precursor of human calcitonin, has been detected in patients with inflammatory conditions from bacterial infection. The formation and release of PCT seems to be a selective induced response to bacterial inflammation or sepsis and it is sustained during a prolonged period of time compared with other inflammatory mediators. In relation to this, PCT could be an important parameter to evaluate patients with AP as systemic involvement and infectious complications that influence the antibiotic use, CT scan indication, invasive hemodynamic monitoring, and surgical intervention are frequently.

Patients and methods

A prospective study was undertaken in patients with diagnosis of AP. The clinical classification was made according to the Symposium of Atlanta and radiological findings by Balthazar's criteria. The presence of infection and multiple organ failure (MOF) were evaluated in a daily basis until hospital discharge or death. These findings were correlated with PCT serum levels that were determined by monoclonal antibodies (Lumitest; B.R.A.H.M.S. Diagnóstica; Germany). Kruskal-Wallis and Mann-Whitney tests were used for statistical analysis.

Results

Ten patients presented with mild AP and three with severe AP that had their PCT level measured in the first 48 h from admission were enrolled. Only the severe AP patients developed infection conditions and MOF. The PCT serum levels in mild and severe AP patients in admission were 0.65 ± 0.29 ng/ml (0.34 ng/ml to 1.45 ng/ml) and 13.68 ± 12.23 ng/ml (2.5 ng/ml to 26.58 ng/ml), respectively. The PCT serum levels were higher in severe AP patients (P = 0.09), when infectious conditions (P = 0.08) and MOD (P= 0.003) were present. All patients that died had high PCT serum levels (P = 0.008).

Conclusion

Increased serum PCT levels may be a predictive parameter of infection and MOF development during AP and correlated with high mortality rate.