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Start Over Topic prognosis Journal langenbecks archiv fur chirurgie
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50. Procalcitonin – a new marker for the acute-phase reaction in acute pancreatitis

Author

A. Richter, Mark Hartel, H. Hofheinz, Thomas Bertsch, Johannes Aufenanger, and C. Böhm

Subjects
Adult, Calcitonin, Male, medicine.medical_specialty, Necrosis, Pancreatitis, Alcoholic, Calcitonin Gene-Related Peptide, medicine.medical_treatment, Calcitonin gene-related peptide, Gastroenterology, Procalcitonin, Diagnosis, Differential, Pancreatectomy, Reference Values, Internal medicine, parasitic diseases, medicine, Humans, Protein Precursors, Acute-Phase Reaction, Aged, Interleukin-6, Pancreatitis, Acute Necrotizing, business.industry, Significant difference, Acute-phase protein, Middle Aged, Prognosis, medicine.disease, C-Reactive Protein, Pancreatitis, Acute pancreatitis, Female, Surgery, medicine.symptom, business, Biomarkers
Abstract

Procalcitonin is a protein which is found in elevated concentrations in the blood circulation during systemic bacterial, fungal or protozoal infection. In contrast to classical acute-phase proteins like C-reactive protein or interleukin-6, it is not elevated after operative trauma. In this paper we present current opinions on the assumed induction mechanisms of the protein by cytokines and endotoxin. Furthermore, the clinical value for early detection of systemic infections in abdominal and transplantation surgery is demonstrated by examples from the literature. Our investigation shows that eight patients with necrotizing pancreatitis had a PCT mean value of 6.9 ng/ml on the day of admission. Seven patients with edematous pancreatitis had only a PCT mean value of 0.69 ng/ml. Despite these differences in the mean values, a significant difference between the normal value and the mean value of the group with necrotizing pancreatitis or edematous pancreatitis was not observed due to the wide range of PCT levels in the group of patients with necrotizing pancreatitis. The fact that only a few of the patients had a superinfected necrosis with systemic evasion of bacterias or their toxins may be the reason for this wide range. We suggest that a discrimination between superinfected necrotizing or sterile pancreatitis and edematous pancreatitis by PCT could be possible but more extensive studies with microbiological examination of the necrotic material are required to recognize the subgroups and to establish the real diagnostic efficiency of PCT in clinical practice, especially in the prediction of the outcome of acute pancreatitis.

Published
1997