C-reactive protein, antiproteases and complement factors as objective markers of severity in acute pancreatitis

Abstract

In a series of patients with acute pancreatitis we have studied complement factors, antiproteases (alpha 2-macroglobulin and alpha 1-antiprotease) and C-reactive protein to determine the value of their sequential measurement in the prediction of outcome relative to clinical assessment and current multiple factor scoring systems. Complement factors were unhelpful in predicting the severity of an attack. alpha 2-Macroglobulin levels were significantly lower in complicated attacks during days 3-8 and alpha 1-antiprotease levels were significantly higher during days 4-8. C-reactive protein concentrations showed the best discrimination between mild and complicated attacks, levels rising higher and persisting for longer in complicated attacks; these differences were highly significant from day 2 (the morning after admission) to day 8. The concentrations providing the best discrimination were found to be greater than or equal to 210 mg/l for the peak C-reactive protein (on the second, third or fourth day) and greater than or equal to 120 mg/l for the C-reactive protein at the end of the first week. Analysis demonstrated both the peak or seventh-day C-reactive protein concentration to be of similar accuracy to either the Ranson or Glasgow multiple factor scoring systems and slightly better for attacks associated with gallstones. The C-reactive protein assay is simple, quick to perform, provides useful clinical information and is more likely to be of value and to be adopted into routine clinical practice than multiple factor scoring systems.

Plasma Calprotectin Levels in Patients Suffering from Acute Pancreatitis

“…Although there was a trend for higher Cal values in severe versus mild AP and in necrotizing versus edematous AP, the overlap of values between the groups did not permit any prediction of the course of the disease. On the contrary, serum CRP concentration confirmed its usefulness in distinguishing between severe and mild forms of AP [21,22]. Obviously, it remains to verify whether a later assay of plasma Cal, or its monitoring during the hospital stay, could indicate the severity of AP, but even if so, a late prediction of AP severity is less important.…”

Acute Pancreatitis: Presentation and Risk Assessment

“…It has been demonstrated that peak CRP levels of ≥210 mg/dL can differentiate severe acute pancreatitis from milder forms with a sensitivity of 83-84% and a specificity of 74-85%. (Wilson et al 1989) Similar studies have shown that high CRP levels have an overall accuracy of 93% in detecting pancreatic necrosis. CRP levels are easy to measure, widely available, and relatively inexpensive to perform.…”

“…C-reactive protein (CRP) is an acute phase reactant that is elevated in several inflammatory conditions and serves as a non-specific marker for inflammation (Wilson et al 1989). In acute pancreatitis, CRP levels commonly peak on the 3 rd or 4 th day after symptom onset, with 48-hour values of 150 mg/dL often accepted as a predictor of subsequent disease severity (Dervenis et al 1999).…”

History and Evolution of the Management of Acute Pancreatitis

“…The use of secretin may provide additional help in outlining the anatomy of the pancreatic duct (50,51). These advances in C-reactive protein (CRP) is an acute phase reactant produced by the hepatocytes and is commonly used as a biochemical indicator of the severity of pancreatitis (2,43). The elevation in CRP is usually evident in severe pancreatitis by the second to fourth days of symptoms, and although the accuracy can be 0.84, it is a late event in the management of patients.…”

“…The elevation in CRP is usually evident in severe pancreatitis by the second to fourth days of symptoms, and although the accuracy can be 0.84, it is a late event in the management of patients. Levels above 120 mg/L are indicative of severe disease (43).…”