Clinical evaluation of the effectiveness of procalcitonin in diagnosing purulent septic complications of acute necrotizing pancreatitis

Abstract

Purulent septic complications seriously worsen the prognosis for patients with acute necrotizing pancreatitis. Early diagnosis is an important issue in establishing the effectiveness of their conservative and interventional treatment. Recently, procalcitonin (PCT) has been suggested as a diagnostic criterion for bacterial contamination of pancreatic necrotic tissue.
 The aim of study is to estimate PCT efficacy for early diagnosis of purulent septic complications of acute necrotizing pancreatitis and to investigate its use for disease prognosis.
 Materials and methods. A prospective cohort study of 151 patients with severe acute necrotizing pancreatitis was conducted. Clinical, laboratory, and bacteriological studies were carried out. Serum levels of PCT were determined during hospitalization, before intervening treatment, and in the postoperative period.
 Results and discussion. Infected acute necrotizing pancreatitis was diagnosed in 89 (55.6%) patients. Local purulent complications were revealed in 27 patients, sepsis in 33, and septic shock in 29. PCT concentration was higher in 62 patients with sterile pancreatic necrosis than in healthy individuals, reaching 1.34±0.19 ng/ml (p=0.045). The development of infected acute necrotizing pancreatitis was accompanied by increased PCT levels in patients with sepsis (up to 5.03±1.38 ng/ml; p=0.001), septic shock (up to 7.21±1.91 ng/ml; p=0.001), and local purulent septic complications (up to 2.03±0.48 ng/ml; p=0.072). The PCT levels above 4.0 ng/ml were prognostically unfavorable for patient survival.
 Conclusion. PCT levels in the blood serum are an effective criterion for diagnosing generalized purulent septic complications of acute necrotizing pancreatitis. Its levels above 4.0 ng/ml indicate an unfavorable prognosis for patient survival.