Value of routine clinical tests in predicting the development of infected pancreatic necrosis in severe acute pancreatitis.
OBJECTIVE
Fine-needle aspiration (FNA) is the procedure of choice for accurate diagnosis of infected necrosis. However, invasive procedures increase the risk of secondary pancreatic infection and the timing of FNA is still a matter for debate. Our objective was to assess the value of routine clinical tests to determine the minimal risk for infected necrosis, thereby optimizing timing and selection of patients for image-guided FNA.


METHODS
This prospective, non-randomized study comprised 90 patients with acute necrotizing pancreatitis. The data of 52 patients were used for discriminant function analysis to determine the differences between patients with infected necrosis and those with sterile necrosis. Cut-off points for variables were established using receiver operating characteristic (ROC) curve analysis and logistic regression was performed to determine the risk of infected necrosis. The clinical relevance of the defined diagnostic system was prospectively tested in a further 38 consecutive patients with acute necrotizing pancreatitis (ANP).


RESULTS
Discriminant function analysis showed that C-reactive protein (CRP) and white blood cell (WBC) values were significant discriminators between patients with sterile necrosis and those with infected necrosis. Cut-off values of 81 mg/l for CRP and 13 x 10(9)/l for WBC were established. The predicted risk for infected necrosis is approx. 1.4% if both tests are below the defined cut-off values. Consequently, we found FNA unnecessary in this subset of patients, unless otherwise indicated, as this invasive procedure per se carries a certain risk of bacterial contamination.


CONCLUSIONS
Routine clinical tests are helpful in diagnosing the development of infected necrosis. Based on the application of classification functions, the timing and selection of patients for image-guided FNA can be optimized.
Dambrauskas
Zilvinas
Z
Laboratory for Research of the GI Tract, Institute for Biomedical Research, Kaunas University of Medicine, Kaunas, Lithuania.
Gulbinas
Antanas
A
Pundzius
Juozas
J
Barauskas
Giedrius
G
D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010179:Pancreas / Q000473:pathology*; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis* / Q000473:pathology* / Q000628:therapy; D018579:Patient Selection; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D000516:alpha-Amylases / Q000097:blood
D002097:C-Reactive Protein; D000516:alpha-Amylases