Role of procalcitonin and granulocyte colony stimulating factor in the early prediction of infected necrosis in severe acute pancreatitis

Abstract

Background: Infected pancreatic necrosis (IPN) is the main cause of death in patients with severe acute pancreatitis. Therefore an early prediction of IPN is of utmost importance.

Aim: Analysis of new blood variables as potential early predictors to differentiate between IPN and sterile pancreatic necrosis (SPN).

Patients: 64 consecutive patients with acute pancreatitis were enrolled in this prospective study; 29 were suffering from acute oedematous pancreatitis (AIP), and 35 from necrotising disease (NP) as diagnosed by contrast enhanced computed tomography.

Methods: Procalcitonin (PCT) and granulocyte colony stimulating factor (G-CSF) in the serum were examined and compared with C reactive protein (CRP). CRP was measured with a turbidimetric immunoassay (Autokit CRP; Wako, Osaka, Japan), and PCT and G-CSF by ELISA (Lumitest PCT; Brahms Diagnostica, Berlin, Germany; G-CSF-Elisa; R&D Systems, Abingdon, Oxon, UK). Monitoring was performed daily and related to the onset of symptoms.

Results: Within the first week, all three variables (CRP, PCT, and G-CSF) were significantly higher in patients with NP than in those with AIP (CRP, p<0.001; G-CSF, p<0. 001; PCT, p<0.001). During the course of the study, 12 of the 35 patients with NP developed late IPN after a median of 20.5 (range 3-49) days. Neither the peak nor the lowest concentrations during the monitoring period were of any value for predicting IPN (median peak values in SPN v IPN: PCT, 0.93 v 1.93 ng/ml; G-CSF, 347 v 421 pg/ml; CRP, 270 v 325 mg/l).

Conclusions: Serum PCT, G-CSF, and CRP concentrations are of similar value for early differentiation between mild and severe acute pancreatitis. However, these variables are not suitable for the early prediction of IPN.

Figure 1

Median concentrations and quartile ranges for C reactive protein (CRP). (A) Acute oedematous pancreatitis compared with acute necrotising pancreatitis; (B) median peak values and ranges in patients with acute oedematous pancreatitis or acute necrotising pancreatitis and sterile pancreatic necrosis or infected pancreatic necrosis.

Figure 2

Receiver operating characteristics curves for (A) C reactive protein (CRP), (B) granulocyte colony stimulating factor (G-CSF), and (C) procalcitonin (PCT). For CRP (A), the cut off was >250 mg/l, sensitivity 83.3%, specificity 70%, and area under the curve 0.793; for G-CSF (B), the cut off was >100.9 pg/l, sensitivity 91.7%, specificity 48%, and area under the curve 0.718; for PCT (C), the cut off was >0.48 ng/l, sensitivity 91.7%, specificity 61.2%, and area under the curve 0.774.

Figure 3

Median concentrations and quartile ranges for granulocyte colony stimulating factor (G-CSF). (A) Acute oedematous pancreatitis compared with acute necrotising pancreatitis; (B) median peak values and ranges in patients with acute oedematous pancreatitis or acute necrotising pancreatitis and sterile pancreatic necrosis or infected pancreatic necrosis.

Figure 4

Median values and quartile ranges for procalcitonin (PCT). (A) Acute oedematous pancreatitis compared with acute necrotising pancreatitis; (B) median peak values and ranges in patients with acute oedematous pancreatitis or acute necrotising pancreatitis and sterile pancreatic necrosis or infected pancreatic necrosis.