The value of procalcitonin in acute pancreatitis and pancreatic infection_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

MA Jinpo , XU Dequan , ZHAO Jiabin , ZHOU Haoxin ,  HOU Limin

Department of Emergency Surgery, The First Affiliated Hospital, Harbin Medical University, Harbin 150001, P. R. China;

Corresponding?author：

HOU Limin, Email: houlimin1969@163.com

Keywords：

procalcitonin; severe acute pancreatitis; acute pancreatitis; pancreatic infection and necrosis; review

DOI：

10.7507/1007-9424.202004045

Video：

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Objective To summarize the clinical value of procalcitonin (PCT) in the prediction of early stage of acute pancreatitis, the evaluation of therapeutic effect, the evaluation of prognosis, and the use of antibiotics.Method We reviewed the related literatures about hematology indexes of severe acute pancreatitis and pancreatic infection and necrosis at home and abroad in recent years.Results PCT had high sensitivity and specificity in the diagnosis of severe acute pancreatitis and pancreatic infection and necrosis, and could be used as a tool to guide the early clinical treatment of severe acute pancreatitis. In the course of treatment, with the improvement of the condition, the value of PCT decreased. Monitoring the change of PCT value could evaluate the therapeutic effect of severe acute pancreatitis. Monitoring PCT during treatment could also guide the use of antibiotics.Conclusion PCT can be used as an early indicator for predicting severe acute pancreatitis and necrosis of pancreatic infection, as well as an indicator for guiding antibiotic treatment.

Citation： MA Jinpo, XU Dequan, ZHAO Jiabin, ZHOU Haoxin, HOU Limin. The value of procalcitonin in acute pancreatitis and pancreatic infection. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(1): 130-134. doi: 10.7507/1007-9424.202004045 Copy

1.	Colvin SD, Smith EN, Morgan DE, et al. Acute pancreatitis: an update on the revised Atlanta classification. Abdom Radiol (NY), 2020, 45(5): 1222-1231.
2.	中華醫學會消化病學分會胰腺疾病學組, 中華胰腺病雜志編輯委員會中華消化雜志編輯委員會. 中國急性胰腺炎診治指南 (2019 年, 沈陽). 中華消化雜志, 2019, 39(11): 721-730.
3.	Jinno N, Hori Y, Naitoh I, et al. Predictive factors for the mortality of acute pancreatitis on admission. PLoS One, 2019, 14(8): e0221468.
4.	Zhou H, Mei X, He X, et al. Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase: a retrospective study. Medicine (Baltimore), 2019, 98(16): e15275.
5.	Simon L, Gauvin F, Amre DK, et al. Serum procalcitonin andC-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis, 2004, 39(2): 206-217.
6.	陳中建, 趙永福. 探討血清中 hs-CRP、降鈣素原及 IL-8 的變化在急性胰腺炎診療中的意義. 中國醫師雜志, 2018, 20(5): 771-773.
7.	Yang CJ, Chen J, Phillips AR, et al. Predictors of severe and critical acute pancreatitis: a systematic review. Dig Liver Dis, 2014, 46(5): 446-451.
8.	Hagjer S, Kumar N. Evaluation of the BISAP scoring system in prognostication of acute pancreatitis - a prospective observational study. Int J Surg, 2018, 54(Pt A): 76-81.
9.	Lee KJ, Kim HM, Choi JS, et al. Comparison of predictive systems in severe acute pancreatitis according to the revised Atlanta classification. Pancreas, 2016, 45(1): 46-50.
10.	Simsek O, Kocael A, Kocael P, et al. Inflammatory mediators in the diagnosis and treatment of acute pancreatitis: pentraxin-3, procalcitonin and myeloperoxidase. Arch Med Sci, 2018, 14(2): 288-296.
11.	Liang Y, Zhao X, Meng F. Procalcitonin, C-reactive protein, and neutrophil ratio contribute to the diagnosis and prognosis of severe acute pancreatitis. Iran J Public Health, 2019, 48(12): 2177-2186.
12.	Caluianu EI, Alexandru DO, Georgescu M, et al. Utilizing multiparameter scores and procalcitonin as prognosis markers for the degree of severity of acute pancreatitis. Curr Health Sci J, 2017, 43(4): 311-317.
13.	Huang HL, Nie X, Cai B, et al. Procalcitonin levels predict acute kidney injury and prognosis in acute pancreatitis: a prospective study. PLoS One, 2013, 8(12): e82250.
14.	Li X, Cao Y, Liu Z, et al. The relationship between liver injury and serum levels of C-reactive protein and procalcitonin in patients with acute pancreatitis. J Coll Physicians Surg Pak, 2019, 29(3): 287-289.
15.	Yarka? A, Kose A, Bozkurt Babu? S, et al. The value of hematological parameters in acute pancreatitis. Ulus Travma Acil Cerrahi Derg, 2019, 25(5): 453-460.
16.	Mikó A, Vigh é, Mátrai P, et al. Computed tomography severity index vs. other indices in the prediction of severity and mortality in acute pancreatitis: a predictive accuracy meta-analysis. Front Physiol, 2019, 10: 1002.
17.	Pieri G, Agarwal B, Burroughs AK. C-reactive protein and bacterial infection in cirrhosis. Ann Gastroenterol, 2014, 27(2): 113-120.
18.	詹柱, 張大志, 胡鵬, 等. 肝硬化患者并發敗血癥時血清降鈣素原水平的臨床研究. 中華肝臟病雜志, 2015, 23(6): 428-432.
19.	祝孟萍, 朱炳喜. 聯合 PCT、D-D、CRP 及 IL-6 檢測在急性胰腺炎早期的臨床價值. 胃腸病學和肝病學雜志, 2018, 27(10): 1186-1190.
20.	馮所遠, 符史健. 血清淀粉酶、C 反應蛋白、降鈣素原與尿胰蛋白酶原激活肽聯合檢測對急性胰腺炎的診斷價值. 中國普通外科雜志, 2018, 27(3): 377-381.
21.	Modrau IS, Floyd AK, Thorlacius-Ussing O. The clinical value of procalcitonin in early assessment of acute pancreatitis. Am J Gastroenterol, 2005, 100(7): 1593-1597.
22.	Gregoriano C, Heilmann E, Molitor A, et al. Role of procalcitonin use in the management of sepsis. J Thorac Dis, 2020, 12(Suppl 1): S5-S15.
23.	Saeed K, González Del Castillo J, Backous C, et al. Hot topics on procalcitonin use in clinical practice, can it help antibiotic stewardship? Int J Antimicrob Agents, 2019, 54(6): 686-696.
24.	張霖, 黃斌, 楊斌, 等. C 反應蛋白、降鈣素原及降鈣素原乳酸比在重癥急性胰腺炎繼發感染的診斷價值. 肝膽外科雜志, 2018, 26(6): 423-426.
25.	Párniczky A, Lantos T, Tóth EM, et al. Antibiotic therapy in acute pancreatitis: from global overuse to evidence based recommendations. Pancreatology, 2019, 54(6): 686-696.
26.	Mofidi R, Suttie SA, Patil PV, et al. The value of procalcitonin at predicting the severity of acute pancreatitis and development of infected pancreatic necrosis: systematic review. Surgery, 2009, 146(1): 72-81.
27.	Rau BM, Kemppainen EA, Gumbs AA, et al. Early assessment of pancreatic infections and overall prognosis in severe acute pancreatitis by procalcitonin (PCT): a prospective international multicenter study. Ann Surg, 2007, 245(5): 745-754.
28.	Schuetz P, Beishuizen A, Broyles M, et al. Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use. Clin Chem Lab Med, 2019, 57(9): 1308-1318.
29.	Schuetz P, Wirz Y, Sager R, et al. Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis. Lancet Infect Dis, 2018, 18(1): 95-107.
30.	Linscheid P, Seboek D, Nylen ES, et al. In vitro and in vivo calcitonin Ⅰ gene expression in parenchymal cells: a novel product of human adipose tissue. Endocrinology, 2003, 144(12): 5578-5584.
31.	Qu R, Ji Y, Ling Y, et al. Procalcitonin is a good tool to guide duration of antibiotic therapy in patients with severe acute pancreatitis. A randomized prospective single-center controlled trial. Saudi Med J, 2012, 33(4): 382-387.
32.	Siriwardena AK, Jegatheeswaran S, Mason JM, et al. PROCalcitonin-based algorithm for antibiotic use in Acute Pancreatitis (PROCAP): study protocol for a randomised controlled trial. Trials, 2019, 20(1): 463.
33.	Harshit Kumar A, Singh Griwan M. A comparison of APACHE Ⅱ, BISAP, Ranson’s score and modified CTSI in predicting the severity of acute pancreatitis based on the 2012 revised Atlanta Classification. Gastroenterol Rep (Oxf), 2018, 6(2): 127-131.
34.	王賓, 齊文杰, 王紅. 降鈣素原在重癥急性胰腺炎中預測價值的臨床研究. 臨床和實驗醫學雜志, 2017, 16(11): 1110-1113.
35.	Kuo DC, Rider AC, Estrada P, et al. Acute pancreatitis: what’s the score? J Emerg Med, 2015, 48(6): 762-770.
36.	Kwong WT, Ondrejková A, Vege SS. Predictors and outcomes of moderately severe acute pancreatitis–evidence to reclassify. Pancreatology, 2016, 16(6): 940-945.
37.	Venkatesh NR, Vijayakumar C, Balasubramaniyan G, et al. Comparison of different scoring systems in predicting the severity of acute pancreatitis: a prospective observational study. Cureus, 2020, 12(2): e6943.

1. Colvin SD, Smith EN, Morgan DE, et al. Acute pancreatitis: an update on the revised Atlanta classification. Abdom Radiol (NY), 2020, 45(5): 1222-1231.
2. 中華醫學會消化病學分會胰腺疾病學組, 中華胰腺病雜志編輯委員會中華消化雜志編輯委員會. 中國急性胰腺炎診治指南 (2019 年, 沈陽). 中華消化雜志, 2019, 39(11): 721-730.
3. Jinno N, Hori Y, Naitoh I, et al. Predictive factors for the mortality of acute pancreatitis on admission. PLoS One, 2019, 14(8): e0221468.
4. Zhou H, Mei X, He X, et al. Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase: a retrospective study. Medicine (Baltimore), 2019, 98(16): e15275.
5. Simon L, Gauvin F, Amre DK, et al. Serum procalcitonin andC-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis, 2004, 39(2): 206-217.
6. 陳中建, 趙永福. 探討血清中 hs-CRP、降鈣素原及 IL-8 的變化在急性胰腺炎診療中的意義. 中國醫師雜志, 2018, 20(5): 771-773.
7. Yang CJ, Chen J, Phillips AR, et al. Predictors of severe and critical acute pancreatitis: a systematic review. Dig Liver Dis, 2014, 46(5): 446-451.
8. Hagjer S, Kumar N. Evaluation of the BISAP scoring system in prognostication of acute pancreatitis - a prospective observational study. Int J Surg, 2018, 54(Pt A): 76-81.
9. Lee KJ, Kim HM, Choi JS, et al. Comparison of predictive systems in severe acute pancreatitis according to the revised Atlanta classification. Pancreas, 2016, 45(1): 46-50.
10. Simsek O, Kocael A, Kocael P, et al. Inflammatory mediators in the diagnosis and treatment of acute pancreatitis: pentraxin-3, procalcitonin and myeloperoxidase. Arch Med Sci, 2018, 14(2): 288-296.
11. Liang Y, Zhao X, Meng F. Procalcitonin, C-reactive protein, and neutrophil ratio contribute to the diagnosis and prognosis of severe acute pancreatitis. Iran J Public Health, 2019, 48(12): 2177-2186.
12. Caluianu EI, Alexandru DO, Georgescu M, et al. Utilizing multiparameter scores and procalcitonin as prognosis markers for the degree of severity of acute pancreatitis. Curr Health Sci J, 2017, 43(4): 311-317.
13. Huang HL, Nie X, Cai B, et al. Procalcitonin levels predict acute kidney injury and prognosis in acute pancreatitis: a prospective study. PLoS One, 2013, 8(12): e82250.
14. Li X, Cao Y, Liu Z, et al. The relationship between liver injury and serum levels of C-reactive protein and procalcitonin in patients with acute pancreatitis. J Coll Physicians Surg Pak, 2019, 29(3): 287-289.
15. Yarka? A, Kose A, Bozkurt Babu? S, et al. The value of hematological parameters in acute pancreatitis. Ulus Travma Acil Cerrahi Derg, 2019, 25(5): 453-460.
16. Mikó A, Vigh é, Mátrai P, et al. Computed tomography severity index vs. other indices in the prediction of severity and mortality in acute pancreatitis: a predictive accuracy meta-analysis. Front Physiol, 2019, 10: 1002.
17. Pieri G, Agarwal B, Burroughs AK. C-reactive protein and bacterial infection in cirrhosis. Ann Gastroenterol, 2014, 27(2): 113-120.
18. 詹柱, 張大志, 胡鵬, 等. 肝硬化患者并發敗血癥時血清降鈣素原水平的臨床研究. 中華肝臟病雜志, 2015, 23(6): 428-432.
19. 祝孟萍, 朱炳喜. 聯合 PCT、D-D、CRP 及 IL-6 檢測在急性胰腺炎早期的臨床價值. 胃腸病學和肝病學雜志, 2018, 27(10): 1186-1190.
20. 馮所遠, 符史健. 血清淀粉酶、C 反應蛋白、降鈣素原與尿胰蛋白酶原激活肽聯合檢測對急性胰腺炎的診斷價值. 中國普通外科雜志, 2018, 27(3): 377-381.
21. Modrau IS, Floyd AK, Thorlacius-Ussing O. The clinical value of procalcitonin in early assessment of acute pancreatitis. Am J Gastroenterol, 2005, 100(7): 1593-1597.
22. Gregoriano C, Heilmann E, Molitor A, et al. Role of procalcitonin use in the management of sepsis. J Thorac Dis, 2020, 12(Suppl 1): S5-S15.
23. Saeed K, González Del Castillo J, Backous C, et al. Hot topics on procalcitonin use in clinical practice, can it help antibiotic stewardship? Int J Antimicrob Agents, 2019, 54(6): 686-696.
24. 張霖, 黃斌, 楊斌, 等. C 反應蛋白、降鈣素原及降鈣素原乳酸比在重癥急性胰腺炎繼發感染的診斷價值. 肝膽外科雜志, 2018, 26(6): 423-426.
25. Párniczky A, Lantos T, Tóth EM, et al. Antibiotic therapy in acute pancreatitis: from global overuse to evidence based recommendations. Pancreatology, 2019, 54(6): 686-696.
26. Mofidi R, Suttie SA, Patil PV, et al. The value of procalcitonin at predicting the severity of acute pancreatitis and development of infected pancreatic necrosis: systematic review. Surgery, 2009, 146(1): 72-81.
27. Rau BM, Kemppainen EA, Gumbs AA, et al. Early assessment of pancreatic infections and overall prognosis in severe acute pancreatitis by procalcitonin (PCT): a prospective international multicenter study. Ann Surg, 2007, 245(5): 745-754.
28. Schuetz P, Beishuizen A, Broyles M, et al. Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use. Clin Chem Lab Med, 2019, 57(9): 1308-1318.
29. Schuetz P, Wirz Y, Sager R, et al. Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis. Lancet Infect Dis, 2018, 18(1): 95-107.
30. Linscheid P, Seboek D, Nylen ES, et al. In vitro and in vivo calcitonin Ⅰ gene expression in parenchymal cells: a novel product of human adipose tissue. Endocrinology, 2003, 144(12): 5578-5584.
31. Qu R, Ji Y, Ling Y, et al. Procalcitonin is a good tool to guide duration of antibiotic therapy in patients with severe acute pancreatitis. A randomized prospective single-center controlled trial. Saudi Med J, 2012, 33(4): 382-387.
32. Siriwardena AK, Jegatheeswaran S, Mason JM, et al. PROCalcitonin-based algorithm for antibiotic use in Acute Pancreatitis (PROCAP): study protocol for a randomised controlled trial. Trials, 2019, 20(1): 463.
33. Harshit Kumar A, Singh Griwan M. A comparison of APACHE Ⅱ, BISAP, Ranson’s score and modified CTSI in predicting the severity of acute pancreatitis based on the 2012 revised Atlanta Classification. Gastroenterol Rep (Oxf), 2018, 6(2): 127-131.
34. 王賓, 齊文杰, 王紅. 降鈣素原在重癥急性胰腺炎中預測價值的臨床研究. 臨床和實驗醫學雜志, 2017, 16(11): 1110-1113.
35. Kuo DC, Rider AC, Estrada P, et al. Acute pancreatitis: what’s the score? J Emerg Med, 2015, 48(6): 762-770.
36. Kwong WT, Ondrejková A, Vege SS. Predictors and outcomes of moderately severe acute pancreatitis–evidence to reclassify. Pancreatology, 2016, 16(6): 940-945.
37. Venkatesh NR, Vijayakumar C, Balasubramaniyan G, et al. Comparison of different scoring systems in predicting the severity of acute pancreatitis: a prospective observational study. Cureus, 2020, 12(2): e6943.

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The value of procalcitonin in acute pancreatitis and pancreatic infection

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