Corticosteroid-binding globulin: a possible early predictor of infection in acute necrotizing pancreatitis.
OBJECTIVE
Infected pancreatic necrosis is the main cause of death in patients with acute pancreatitis, and therefore its early prediction is of utmost importance. Endogenous cortisol metabolism plays a basic role both in the course of acute pancreatitis and in the process of infection. The purpose of this study was to analyze corticosteroid-binding globulin (CBG), total cortisol, calculated free cortisol and adrenocorticotropic hormone as potential early predictors in order to differentiate between infected pancreatic necrosis and sterile pancreatic necrosis in patients with acute pancreatitis.


METHODS
Serum levels of CBG, total cortisol, calculated free cortisol, and plasma levels of adrenocorticotropic hormone were determined in 109 consecutive patients with acute pancreatitis. C-reactive protein was measured as the control parameter. Thirty-five patients developed necrotizing pancreatitis and 10 developed infection of the necrosis. Blood was monitored for 6 days after the onset of pain; 30 healthy individuals served as controls.


RESULTS
Of all parameters only CBG showed a significant difference (p = 0.0318) in its peak levels measured in the first 48 h in patients with sterile (26.5 microg/ml, range 21.3-34.7) and infected (16.0 microg/ml, range 15.2-25.0) necrosis at a cut-off level of 16.8 microg/ml. That difference was further preserved for the first 6 days after onset of pain.


CONCLUSIONS
In our group of patients, a decreased CBG level below 16.8 g/ml within the initial 48 h of acute pancreatitis was an early predictor of later infected pancreatic necrosis, with a positive predictive value of 100% and a negative predictive value of 87.5%.
Muller
Christophe A
CA
Department of General Surgery, St. Josef Hospital, Ruhr University Bochum, Germany. c.mueller@klinikum-bochum.de
Belyaev
Orlin
O
Vogeser
Michael
M
Weyhe
Dirk
D
Gloor
Beat
B
Strobel
Oliver
O
Werner
Jens
J
Borgstrom
Anders
A
Buchler
Markus W
MW
Uhl
Waldemar
W
D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000175:diagnosis*; D002097:C-Reactive Protein / Q000032:analysis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications*; D011237:Predictive Value of Tests; D013997:Time Factors; D014156:Transcortin / Q000032:analysis*
D000324:Adrenocorticotropic Hormone; D002097:C-Reactive Protein; D014156:Transcortin; D006854:Hydrocortisone