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


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


METHODS
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.
Müller
C A
CA
Department of Visceral and Transplantation Surgery, University Hospital of Bern, CH-3010 Bern, Switzerland.
Uhl
W
W
Printzen
G
G
Gloor
B
B
Bischofberger
H
H
Tcholakov
O
O
Büchler
M W
MW
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002096:C-Peptide / Q000032:analysis; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D019283:Pancreatitis, Acute Necrotizing / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology; D011498:Protein Precursors / Q000097:blood*
D015415:Biomarkers; D002096:C-Peptide; C000606589:CALCA protein, human; D011498:Protein Precursors; D016179:Granulocyte Colony-Stimulating Factor; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide