B Rau1, M K Schilling, H G Beger. 1. Department of General, Visceral, and Vascular Surgery, University of the Saarland, Homburg/Saar, Germany. bettina.rau@uniklinik-saarland.de
Abstract
BACKGROUND: A large array of parameters has been proposed for the biochemical stratification of severity and prediction of complications in acute pancreatitis. However, the number of accurate and readily available variables for routine application is still limited. METHODS: The literature was reviewed for laboratory markers of acute pancreatitis with special regard to their clinical usefulness and test performance for stratifying severity and monitoring disease progression. RESULTS: Several parameters, such as trypsinogen and procarboxypeptidase B activation peptide, PMN-elastase, interleukin-6 (IL-6) and 8 (IL-8), serum amyloid A (SAA), and procalcitonin (PCT), can differentiate between mild and severe acute pancreatitis within 48 h of disease onset with favorable diagnostic accuracy. Because fully automated assays have become available, IL-6, IL-8, PCT, and SAA are the most interesting parameters in this respect. For monitoring disease progression beyond 48 h, acute-phase proteins, IL-6, IL-8, and PCT are valuable markers. PCT is the first biochemical variable for predicting severe pancreatic infections and overall prognosis throughout the course of acute pancreatitis with high sensitivity and specificity. CONCLUSIONS: Among all the biochemical variables available, C-reactive protein is still the standard for a fast, reliable, and cost-effective assessment of severity in acute pancreatitis. PCT substantially contributes to an improved stratification of patients at risk to develop major complications and deserves routine application.
BACKGROUND: A large array of parameters has been proposed for the biochemical stratification of severity and prediction of complications in acute pancreatitis. However, the number of accurate and readily available variables for routine application is still limited. METHODS: The literature was reviewed for laboratory markers of acute pancreatitis with special regard to their clinical usefulness and test performance for stratifying severity and monitoring disease progression. RESULTS: Several parameters, such as trypsinogen and procarboxypeptidase B activation peptide, PMN-elastase, interleukin-6 (IL-6) and 8 (IL-8), serum amyloid A (SAA), and procalcitonin (PCT), can differentiate between mild and severe acute pancreatitis within 48 h of disease onset with favorable diagnostic accuracy. Because fully automated assays have become available, IL-6, IL-8, PCT, and SAA are the most interesting parameters in this respect. For monitoring disease progression beyond 48 h, acute-phase proteins, IL-6, IL-8, and PCT are valuable markers. PCT is the first biochemical variable for predicting severe pancreatic infections and overall prognosis throughout the course of acute pancreatitis with high sensitivity and specificity. CONCLUSIONS: Among all the biochemical variables available, C-reactive protein is still the standard for a fast, reliable, and cost-effective assessment of severity in acute pancreatitis. PCT substantially contributes to an improved stratification of patients at risk to develop major complications and deserves routine application.
Authors: Alberto Schanaider; Thales Penna de Carvalho; Simone de Oliveira Coelho; Juan Miguel Renteria; Elis Cristina Araújo Eleuthério; Morgana Teixeira Lima Castelo-Branco; Kalil Madi; Wagner Baetas-da-Cruz; Heitor Siffert Pereira de Souza Journal: Clin Exp Med Date: 2014-06-17 Impact factor: 3.984
Authors: Bettina M Rau; Esko A Kemppainen; Andrew A Gumbs; Markus W Büchler; Karl Wegscheider; Claudio Bassi; Pauli A Puolakkainen; Hans G Beger Journal: Ann Surg Date: 2007-05 Impact factor: 12.969
Authors: Joseph A Sennello; Raja Fayad; Maria Pini; Melissa E Gove; Venkatesh Ponemone; Robert J Cabay; Britta Siegmund; Charles A Dinarello; Giamila Fantuzzi Journal: Proc Natl Acad Sci U S A Date: 2008-05-30 Impact factor: 11.205