A Study of Procalcitonin as an Early Predictor of Severity in Acute Pancreatitis

Abstract

Acute Pancreatitis is an acute inflammation of the pancreas.Acute pancreatitis is an acute inflammatory process ranging clinically from mild discomfort with localized inflammation to severe disease involving remote organ systems. There is a continuum from the development of systemic inflammatory response syndrom, to the onset of multiple organ dysfunction (MODS), which is seen in about 24% of patients with acute pancreatitis and carries the highest mortality rate of 36%, and imaging tests showing characteristic findings of acute pancreatitis. Several inflammatory markers are being used routinely in various hospitals in India to assess the prognosis of patients with acute pancreatitis. Among these are the total and differential leukocyte counts, erythrocyte sedimentation rate, and C-reactive protein (CRP), interleukin-6, thioredoxin-1, and polymorphonuclear elastase. serum procalcitonin is one of the components to assess the severity of pancreatitis. Procalcitonin is an acute phase reactant that has been extensively investigated as early marker in systemic bacterial infection, sepsis, and multi organ failure. Because severe acute pancreatitis is associated with sepsis, infected pancreatic necrosis, and multi organ failure. Procalcitonin can be used as a useful marker in early prediction of severity.

Material: a prospective observational hospital based study conducted on patients of Department of General Medicine with collaboration from Department of Biochemistry and Radio diagnosis of SMS Medical College Jaipur. Patient who were diagnosed as case of acute pancreatitis on basis of diagnostic criteria as per Atlanta classification 2013 guidelines7 were included. Total of 56 cases were included in this study.

Observation: The finding observed are as under:- 1) The mean age of the population was 38.5 ±11.83 years.

Conclusion: In present, study serum PCT was done in patients diagnosed as acute pancreatitis on basis of Atlanta classification within 48 hours of admission and was found to be increased (value is significant if it is more than 0.5ng/ml) in 23 patients out of 60, with mean of 1.94±2.4ng /ml. These 23 patients were later on found to have severe acute pancreatitis on the basis Atlanta classification and rest 37 patients who had mild pancreatitis had mean PCT 0.38±0.66ng/ml. A study conducted on 40 patients of acute pancreatitis which was confirmed by Computed tomography was conducted in Poland, where they collected blood samples on admission and 24 hour thereafter, in which they tried to evaluate the role of procalcitonin as an early predictor of course of acute pancreatitis and they found that procalcitonin concentration was significantly higher in patients of acute pancreatitis and cut off was estimated at 0.5ng/ml.79 Similarly, in this study PCT was found to be high in patients of severe acute pancreatitis only.