C-REACTIVE PROTEIN AND PROCALCITONIN AS INDEPENDENT PROGNOSTIC MARKERS IN ACUTE PANCREATITIS
Abstract:
Severe acute pancreatitis (SAP) is one of the main causes of intra-abdominal hypertension of
retroperitoneal origin, which can lead to multiple system organ failure (MSOF). Mortality rate of SAP
remains high between 15% and 30%, and is the result of pancreatic necrosis infection and MSOF.
Circulatory level of C-reactive protein (CRP) is an independent predictor of the evolution of acute
pancreatitis. Measurement of serum CRP is the best test available to identify pancreatic necrosis. There
is no correlation between serum levels of CRP and the presence of infected pancreatic necrosis.
Procalcitonin is a precursor of calcitonin, which was shown to be a marker for severe bacterial and
fungal infections. Materials and methods: The study included 48 patients hospitalized in the Clinical
County Emergency Hospital of Sibiu, between October 2011 and January 2013, diagnosed with acute
pancreatitis. Evolution of values of procalcitonin (PCT) and C-reactive protein (CRP) was analysed, as
markers of prognosis in acute pancreatitis. Results: 48 hours after admission, for a cut-off value of 150
mg/L, CRP had a sensitivity (Se) of 76% and a specificity (Sp) of 88%, positive predictive value (PPV) of
81%, negative predictive value (NPV) of 86% and an accuracy of 84% for predicting the severe
development of acute pancreatitis [AUC: 0.844 (95% CI: 0.732 to 0.956), p <0.001]. The maximum
values of PCT had a biphasic trend with a slight increase of the maximum values on the 2nd day of
hospitalization in most patients and later, 10 days after admission, in patients with septic complications.
Conclusions: CRP values after 48 hours could be correlated with traditional prognostic scores
(APACHE II and Ranson). PCT maximum values were associated with severe inflammation, bacterial
translocation, septic complications and mortality rate in AP.
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