Efficacy of presepsin, procalcitonin, Il-6 and C-reactive protein for diagnosis of system and local infection in patients with acute necrotizing pancreatitis

Abstract

Introduction: Sepsis and organ failure are results of progress of infected acute necrotizing pancreatitis (ANP) and their development significantly worsens its prognosis. Early diagnosis of infection can improve results of their management. Aim of study was to establish the efficacy of presepsin (PSP), procalcitonin (PCT), Il-6 and C-reactive protein (CRP) for diagnosis of local and system infection during ANP. Method: In 70 patients with ANP levels of PSP, PCT, Il-6 and CRP at admission and during treatment were determined and compared with bacteriological assays, complications and mortality rates. Results: The positive results of bacteriological examination were obtained in 43 cases. In patients with ANP and system inflammatory response syndrome without infection the concentration of the PSP increased to 332±38 pg/ml (healthy control - 184±16 pg/ml, p< 0.05). There was direct dependence of PSP concentration from severity of infection: at local infection its level reached 677±30 pg/ml, sepsis - 988±47 pg/ml and severe sepsis - 2668±102 pg/ml. PCT concentgration over 2.5 ng/ml differentiated septic cases but changes in patients with local infection were insignificant (p˃0.05). High rates of Il-6 and CRP were common in patients with system inflammatory response syndrome of both infectious and noninfectious origin. ROC AUC value of PSP for all types of infection complications reached 0.956±0.007 (p<0.001) and was significantly higher (p˂0.05) than ROC AUC of PCT, Il-6 and CRP. Conclusion: PSP concentration is early highly sensitive and specific marker for all kind of infection complications during ANP and exceeds diagnostic utility of PCT, Il-6 and CRP.