Abstract
Serum procalcitonin (PCT) has been reported as a potential biomarker to predict the severity of acute cholangitis (AC) or the need for urgent biliary decompression. This study aimed to identify and summarize the existing research about serum PCT and the severity of AC, and to find gaps towards which future studies can be targeted. Following the PRISMA extension for scoping reviews, MEDLINE, EMBASE, and Google Scholar were searched for all peer-reviewed articles with relevant keywords including “cholangitis” and “procalcitonin” from their inception to 13 July 2021. We identified six studies. All the studies employed a case-control design and aimed to evaluate the usefulness of serum PCT to predict the severity of AC with key identified outcomes. While the potential cut-off values of serum PCT for severe AC ranged from 1.8–3.1 ng/mL, studies used different severity criteria and the definition of urgent biliary decompression. No studies proposed cut-off PCT values for the need for urgent biliary decompression. This scoping review identified the current level of evidence regarding the usefulness of serum PCT in assessing the severity of AC. Further clinical research is warranted with a focus on standardized outcome measures employing prospective or experimental designs.
Highlights
Acute cholangitis (AC) is a medical emergency and systemic condition due to biliary infection and obstruction with an associated high mortality rate [1,2]
This is a systematic scoping review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR) [16,17]
We identified six primary studies related to serum PCT levels and the severity of AC or other pertinent outcomes such as blood culture positivity, progression to septic shock, need, and timing of biliary decompression, or biliary fluid character on endoscopic retrograde cholangiopancreatography (ERCP)
Summary
Acute cholangitis (AC) is a medical emergency and systemic condition due to biliary infection and obstruction with an associated high mortality rate [1,2]. Before advancements in critical care and the decompression of the biliary duct system, the mortality of AC was reported to be over 50% [2]. Subsequent to 1980, the mortality rates of AC ranged from. 10–30%, with multiorgan failure noted to be the cause of death [3]. The majority of cases of AC are due to biliary duct stones. The variety of additional etiologies underscores a wide variety of risk factors that influence mortality [3,4]. Procalcitonin (PCT), a 116 amino acid peptide precursor of calcitonin, was initially thought to help identify sepsis patients and was later associated with bacterial infection [5]
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