Procalcitonin levels at admission as a predictor of coexisting acute moderate and severe cholangitis in acute pancreatitis

Abstract

Background: It is clinically and analytically challenging to determine when acute pancreatitis (AP) overlaps with acute cholangitis (AC) in an emergency setting. Starting wide spectrum antibiotics, ordering endoscopic retrograde cholangiopancreatography or CT scans depends upon accurate diagnosis. The aim of our study is to determine whether procalcitonin levels greater or equal than 2ng/ml could differentiate and predict moderate and severe acute cholangitis in AP patients. Methods: Clinical data of 57 AP patients, prospectively enrolled for study at our institution were analyzed. PCT, PCR levels were dosed during the first 72 hours since symptomatic onset as well as the APACHE-II index and C-reactive protein > 15mg/dl. Moderate and severe acute cholangitis (AC) was reported according Tokyo Criteria 2013 (TG13). In order to determine statistical significance, Pearson´s chi-squared test was used. For determining PCT prediction, area-under-the-curve receiver-operating characteristics (AUC) were applied. Results: Moderate and Severe AC was higher in PCT levels>2ng/ml group (45.5% vs. 2.2%, p= 0.). PCT levels ≥ 2ng/ml outperformed CRP>15mg/dl and APACHE-II for moderate and severe AC prediction with a significant accuracy (AUC 0.804, CI 0.63-1, p=0.013). Conclusion: PCT levels at admission could help rule out and predict concomitant acute pancreatitis and moderate-severe acute cholangitis.