Korean J Gastroenterol.  2011 Jul;58(1):31-37. 10.4166/kjg.2011.58.1.31.

Comparison of Serum Procalcitonin with Ranson, APACHE-II, Glasgow and Balthazar CT Severity Index Scores in Predicting Severity of Acute Pancreatitis

• Woo SM
• Noh MH
• Kim BG
• Hsing CT
• Han JS
• Ryu SH
• Seo JM
• Yoon HA
• Jang JS
• Choi SR
• Cho JH

• KMID: 1792812
• DOI: http://doi.org/10.4166/kjg.2011.58.1.31

Abstract

BACKGROUND/AIMS
The aim of this study is to assess serum procalcitonin (PCT) for early prediction of severe acute pancreatitis compared with multiple scoring systems and biomarkers.
METHODS
Forty-four patients with acute pancreatitis confirmed by radiological evidences, laboratory assessments, and clinical manifestation were prospectively enrolled. All blood samples and image studies were obtained within 24 hours of admission.
RESULTS
Acute pancreatitis was graded as severe in 19 patients and mild in 25 patients according to the Atlanta criteria. Levels of serum PCT were significantly higher in severe acute pancreatitis (p=0.001). The accuracy of serum PCT as a predicting marker was 77.3%, which was similar to the acute physiology and chronic health examination (APACHE)-II score, worse than the Ranson score (93.2%) and better than the Balthazar CT index (65.9%). The most effective cut-off level of serum PCT was estimated at 1.77 ng/mL (AUC=0.797, 95% CI=0.658-0.935). In comparision to other simple biomarkers, serum PCT had more accurate value (77.3%) than C-reactive protein (68.2%), urea (75.0%) and lactic dehydrogenase (72.7%). Logistic regression analysis revealed that serum PCT has statistical significance in acute severe pancreatitis. Assessment of serum PCT levels and length of hospital stay by simple linear regression analysis revealed effective p-value with low R square level, which could make only possibilty for affection of serum PCT to admission duration (r2=0.127, p=0.021).
CONCLUSIONS
Serum PCT was a promising simple biomarker and had similar accuracy of APACHE-II scores as predicting severity of acute pancreatitis.

Keyword

Serum procalcitonin; Acute necrotizing pancreatitis; Multiple scoring systems

MeSH Terms

APACHE
Acute Disease
Adult
Aged
Aged, 80 and over
Area Under Curve
Biological Markers/blood
C-Reactive Protein/analysis
Calcitonin/*blood
Female
Humans
L-Lactate Dehydrogenase/blood
Length of Stay
Logistic Models
Male
Middle Aged
Pancreatitis/*diagnosis/pathology/radiography
Predictive Value of Tests
Protein Precursors/*blood
*Severity of Illness Index
Urea/blood

Figure

• 

  Fig. 1. Mean value of serum levels of procalcitonin in mild and severe acute pancreatitis clossified by Atlanta criteria. Levels of serum procalcitonin were significantly higher in severe acute pancreatitis. Md, mild acute pancreatitis (n=25, SD=4.614); Severe, severe acute pancreatitis (n=24, SD= 53.433). ∗Mann-Whitney U test, p=0.001.

• 

  Fig. 2. Receiver operation characteristic curve of serum levels of procalcitonin in prediction of severity of acute pancreatitis. Numbers of observation=44. AUC, area under curve.

• 

  Fig. 3. Correlation between serum procalcitonin levels and duration of admission in patients with acute pancreatitis. Procalcitonin is indendent variable (x), admission duration is dependent variable (y). Coefficient B is −8.791. Coefficient of determinant (r2)=0.127, t value=2.413, dependent p-value=0.021.

Reference

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