Procalcitonin levels at admission as a predictor of infected pancreatic necrosis in acute pancreatitis

Abstract

Background: Recognizing a priori potential critical patients that could develop local complications (need of invasive procedures and necrosis infection) during acute pancreatitis (AP) onset is determinant for morbimortality and healthcare costs. The aim of the study was to determine whether higher procalcitonin levels, PCR levels ≥15mg/dL and APACHE-II index ≥8 at admission could predict severity of AP and local complications. Methods: Clinical data of 55 AP patients, prospectively enrolled for study at our institution were analyzed. PCT and PCR levels were dosed and APACHE-II index followed during the first 72 hours since symptomatic onset and patients underwent contrast-enhanced CT within the first week of symptom onset. Patients were divided in two groups: PCT ≥ 2ng/ml and PCT< 2ng/ml. Chi-square and area-under-the-curve receiver-operating characteristics (AUC) were applied. Parameters evaluated were: local complications (pancreatic necrosis infection, need for invasive procedures against necrosis) and AP severity; persistent organ and multiorgan failure (PO, PMOF), admission to intensive care unit (ICU), PA severity according to the Atlanta Classification) and mortality. Results: PCT levels ≥ 2ng/ml outperformed CRP ≥15mg/dl and APACHE-II for transient organ failure (AUC 0.757, p=0.04) and infected necrosis (AUC 0.806, p=0.043). For POF, MOF, mortality, need of intensive care unit, prolonged hospital stay, and need for an invasive procedure, none of the biological markers nor the physiological index showed a decent area under the curve and statistical significance. Conclusion: Procalcitonin levels greater or equal than 2ng/ml more accurately predicts organic failure and necrotic pancreatic infection.