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.	中华医学会消化病学分会胰腺疾病学组, 中华胰腺病杂志编辑委员会中华消化杂志编辑委员会. 中国急性胰腺炎诊治指南 (2019 年, 沈阳). 中华消化杂志, 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.	陈中建, 赵永福. 探讨血清中 hs-CRP、降钙素原及 IL-8 的变化在急性胰腺炎诊疗中的意义. 中国医师杂志, 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.	Yarkaç A, Kose A, Bozkurt Babuş 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, 张大志, 胡鹏, 等. 肝硬化患者并发败血症时血清降钙素原水平的临床研究. 中华肝脏病杂志, 2015, 23(6): 428-432.
19.	祝孟萍, 朱炳喜. 联合 PCT、D-D、CRP 及 IL-6 检测在急性胰腺炎早期的临床价值. 胃肠病学和肝病学杂志, 2018, 27(10): 1186-1190.
20.	冯所远, 符史健. 血清淀粉酶、C 反应蛋白、降钙素原与尿胰蛋白酶原激活肽联合检测对急性胰腺炎的诊断价值. 中国普通外科杂志, 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.	张霖, 黄斌, 杨斌, 等. C 反应蛋白、降钙素原及降钙素原乳酸比在重症急性胰腺炎继发感染的诊断价值. 肝胆外科杂志, 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.	王宾, 齐文杰, 王红. 降钙素原在重症急性胰腺炎中预测价值的临床研究. 临床和实验医学杂志, 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. 中华医学会消化病学分会胰腺疾病学组, 中华胰腺病杂志编辑委员会中华消化杂志编辑委员会. 中国急性胰腺炎诊治指南 (2019 年, 沈阳). 中华消化杂志, 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. 陈中建, 赵永福. 探讨血清中 hs-CRP、降钙素原及 IL-8 的变化在急性胰腺炎诊疗中的意义. 中国医师杂志, 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. Yarkaç A, Kose A, Bozkurt Babuş 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, 张大志, 胡鹏, 等. 肝硬化患者并发败血症时血清降钙素原水平的临床研究. 中华肝脏病杂志, 2015, 23(6): 428-432.
19. 祝孟萍, 朱炳喜. 联合 PCT、D-D、CRP 及 IL-6 检测在急性胰腺炎早期的临床价值. 胃肠病学和肝病学杂志, 2018, 27(10): 1186-1190.
20. 冯所远, 符史健. 血清淀粉酶、C 反应蛋白、降钙素原与尿胰蛋白酶原激活肽联合检测对急性胰腺炎的诊断价值. 中国普通外科杂志, 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. 张霖, 黄斌, 杨斌, 等. C 反应蛋白、降钙素原及降钙素原乳酸比在重症急性胰腺炎继发感染的诊断价值. 肝胆外科杂志, 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. 王宾, 齐文杰, 王红. 降钙素原在重症急性胰腺炎中预测价值的临床研究. 临床和实验医学杂志, 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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