title: Procalcitonin as a useful biomarker for determining the need to perform emergency biliary drainage in cases of acute cholangitis.
abstract: BACKGROUND
  It is important to identify biomarkers for sepsis and organ damage in acute cholangitis patients. We investigated the usefulness of procalcitonin (PCT) as a biomarker of inflammation based on the Tokyo Guidelines 2013 (TG13).
  
  
  METHODS
  A total of 110 acute cholangitis patients were categorized based on TG13, and the PCT levels and common laboratory inflammatory markers were measured. The cases undergoing hemoculture (n = 72) at the time of diagnosis also correlated with the PCT levels.
  
  
  RESULTS
  The PCT and C-reactive protein levels were significantly higher in grade III cases versus grade I. The mean PCT levels for positive hemoculture cases (8.6 ng/ml) were significantly higher than those for negative cases (0.7 ng/ml). In hemoculture positive cases or when purulent bile was obtained from the duodenal papilla, i.e., cases clearly requiring emergency biliary drainage and necessitating categorization as grade III, three cases were categorized as grade I and 13 as grade II. Only PCT showed statistically significant increases in severe cases underestimated as grade I or II despite them being fundamentally grade III cases.
  
  
  CONCLUSIONS
  Acute cholangitis with high PCT levels can signify the need to perform emergency biliary drainage and institute intensive care even if categorized by TG13 as not being severe cases.
authors.affiliation: Department of Gastroenterological Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shinya
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Sasaki
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kato
authors.forename: Kanefumi
authors.initials: K
authors.lastname: Yamashita
authors.forename: Ryo
authors.initials: R
authors.lastname: Nakashima
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yamauchi
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Noritomi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002761:Cholangitis / Q000097:blood* / Q000175:diagnosis / Q000601:surgery*; D003952:Diagnostic Imaging; D004322:Drainage; D004630:Emergencies; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011498:Protein Precursors / Q000097:blood*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide
keywords: Acute cholangitis; Procalcitonin; Tokyo Guidelines 2013