The potential role of procalcitonin and interleukin 8 in the prediction of infected necrosis in acute pancreatitis

Abstract

Background-Infection of pancreatic necrosis has a major impact on clinical course, management, and outcome in acute pancreatitis. Currently, guided fine needle aspiration is the only means for an early and accurate diagnosis of infected necrosis. Procalcitonin (PCT), a 116 amino acid propeptide of calcitonin, and interleukin 8 (IL-8), a strong neutrophil activating cytokine, are markers of severe inflammation and sepsis. Aims-To analyse the clinical value of PCT and IL-8 as biochemical parameters for predicting infected necrosis in acute pancreatitis. Patients and methods-Fifty patients with acute pancreatitis entered this prospective study and were stratified into three groups according to morphological and bacteriological findings: 18 patients with oedematous pancreatitis (group I), 14 patients with sterile necrosis (group II), and 18 patients who developed infected necrosis a median of 13.5 days after the onset of symptoms (group III). After admission serum samples were drawn daily for two weeks. Concentrations of PCT and IL-8 were measured by chemoluminescent immunoassays (upper reference range 0.5 ng/ml for PCT and 70 pg/ml for IL-8). The routine parameter C-reactive protein was determined by laser nephelometry (upper reference range 10 mg/l). Results-Median concentrations of PCT and IL-8 were significantly higher in patients with infected necrosis than in those with sterile necrosis during the observation period, whereas there was no diVerence in C-reactive protein. In oedematous pancreatitis overall median concentrations of all three parameters were low. By receiver operating characteristics best cut oV levels for predicting infected necrosis or persisting pancreatic sepsis were 1.8 ng/ml for PCT and 112 pg/ml for IL-8. If these cut oV levels were reached on at least two days, sensitivity, specificity, and accuracy for the prediction of infected necrosis were 94%, 91%, and 92% for PCT and 72%, 75%, and 74% for IL-8, respectively. After surgical treatment of infected necrosis median PCT and IL-8 values continued to be significantly higher in patients with persisting pancreatic sepsis (n=11) compared with those having an uneventful postoperative course (n=7). For the preoperative diVerentiation between infected necrosis and sterile necrosis guided fine needle aspiration was performed in 24 patients with necrotising pancreatitis and reached a diagnostic accuracy of 84% compared with 87% for PCT, and 68% for IL-8. There was no correlation between the aetiology of acute pancreatitis or the extent of necrosis and PCT or IL-8. Conclusion-PCT and IL-8 are found in high concentrations in infected necrosis and associated systemic complications in patients with acute pancreatitis. The course of PCT shows the closest correlation with the presence of infected necrosis. Monitoring of serum PCT is a potential new marker for the non-invasive and accurate prediction of infected necrosis as well as for the selection of patients with persisting septic complications after surgical debridement. (Gut 1997; 41: 832-840)...

Novel Biomarkers to Detect Infection in Revision Hip and Knee Arthroplasties

“…Numerous studies have shown procalcitonin is elevated in cases of bacterial infection or sepsis and levels are considerably higher in bacterial infections than in viral infections [2,5,11,14,21,26,29,30,33]. Procalcitonin increases 2 to 4 hours after the onset of sepsis, which is later than proinflammatory cytokines, such as interleukin 6 (IL-6), but considerably earlier than CRP [31]. It reaches its peak after 6 hours and has a half-life of 25 to 30 hours [13,23].…”

“…It reaches its peak after 6 hours and has a half-life of 25 to 30 hours [13,23]. Some studies have shown the course of procalcitonin serum levels reflects the success of antibiotic treatment of bacterial infection rapidly, closely, and more reliably than CRP level [13,18,29,31,37].…”

Procalcitonin as an early predictor of postoperative infectious complications in patients with acute traumatic spinal cord injury

“…Timely administration of adequate and effective antibiotic therapy is an important factor to solve those problems, and a thorough clinical examination and diagnostic workup is mandatory. Some reports showed that the administration of antibiotics alone had no effect on elevated PCT concentration 20 and simply administering antibiotics in the absence of an infection has no effect on CRP values, 21 suggesting that preoperative antibiotics might not direct influence on the PCT and CRP levels, however, it could have indirect effect on the PCT and CRP levels with presence or absence of infection or other relative condition. On the other hand, many previous studies demonstrated that PCT could be used to guide antibiotic therapy in patients with infection.…”

Prospective evaluation of the BISAP score and its correlation with Marshall score in predicting severity of organ failure in acute pancreatitis

“…11 Rau et al noted a 19 fold increased risk of mortality among 230 patients with sterile necrosis, treated either operatively or conservatively, with multisystem >2 organ failure. 12 In addition to the presence of organ failure, the persistence of organ failure has been shown to a major determinant of mortality in acute pancreatitis. 13,14 In our study, admitted patients in the study group were assessed within 24hrs of presentation and BISAP score was calculated.…”