Laboratory markers of severe acute pancreatitis.
BACKGROUND
A large array of parameters has been proposed for the biochemical stratification of severity and prediction of complications in acute pancreatitis. However, the number of accurate and readily available variables for routine application is still limited.


METHODS
The literature was reviewed for laboratory markers of acute pancreatitis with special regard to their clinical usefulness and test performance for stratifying severity and monitoring disease progression.


RESULTS
Several parameters, such as trypsinogen and procarboxypeptidase B activation peptide, PMN-elastase, interleukin-6 (IL-6) and 8 (IL-8), serum amyloid A (SAA), and procalcitonin (PCT), can differentiate between mild and severe acute pancreatitis within 48 h of disease onset with favorable diagnostic accuracy. Because fully automated assays have become available, IL-6, IL-8, PCT, and SAA are the most interesting parameters in this respect. For monitoring disease progression beyond 48 h, acute-phase proteins, IL-6, IL-8, and PCT are valuable markers. PCT is the first biochemical variable for predicting severe pancreatic infections and overall prognosis throughout the course of acute pancreatitis with high sensitivity and specificity.


CONCLUSIONS
Among all the biochemical variables available, C-reactive protein is still the standard for a fast, reliable, and cost-effective assessment of severity in acute pancreatitis. PCT substantially contributes to an improved stratification of patients at risk to develop major complications and deserves routine application.
Rau
B
B
Department of General, Visceral, and Vascular Surgery, University of the Saarland, Homburg/Saar, Germany. bettina.rau@uniklinik-saarland.de
Schilling
M K
MK
Beger
H G
HG
D000208:Acute Disease; D015415:Biomarkers / Q000378:metabolism*; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D043424:Carboxypeptidase B / Q000378:metabolism; D018450:Disease Progression; D006801:Humans; D007378:Interleukins / Q000097:blood; D009842:Oligopeptides / Q000378:metabolism; D010189:Pancreatic Juice / Q000201:enzymology; D010195:Pancreatitis / Q000175:diagnosis / Q000378:metabolism*; D011498:Protein Precursors / Q000097:blood; D000685:Serum Amyloid A Protein / Q000378:metabolism; D012720:Severity of Illness Index
D015415:Biomarkers; C000606589:CALCA protein, human; D007378:Interleukins; D009842:Oligopeptides; D011498:Protein Precursors; D000685:Serum Amyloid A Protein; C080396:trypsinogen activation peptide; D002116:Calcitonin; D043424:Carboxypeptidase B; D015740:Calcitonin Gene-Related Peptide