PROCALCITONIN: LABORATORY DIAGNOSTIC MARKER OF PURULENT-SEPTIC COMPLICATIONS OF ACUTE NECROTIC PANCREATITIS

  • O V. Rotar HSEE of Ukraine «Bukovinian State Medical University», Department of General Surgery, Chernivtsi, Ukraine https://orcid.org/0000-0002-9434-0377
  • I. V. Khomiak SE «O.O. Shalimov National Institute of Surgery and Transplantology», Department of Pancreas Surgery, Laparoscopic and Reconstructive Surgery of Bile Ducts, Kyiv, Ukraine https://orcid.org/0000-0002-3299-7840
  • R. I. Sydorchuk HSEE of Ukraine «Bukovinian State Medical University», Department of General Surgery, Chernivtsi, Ukraine https://orcid.org/0000-0002-3603-3432
  • V. I. Rotar HSEE of Ukraine «Bukovinian State Medical University», Department of General Surgery, Chernivtsi, Ukraine https://orcid.org/0000-0002-3467-0024
  • R. P. Knut HSEE of Ukraine «Bukovinian State Medical University», Department of General Surgery, Chernivtsi, Ukraine https://orcid.org/0000-0002-3563-5458
Ключові слова: acute pancreatitis, infectious complications, procalcitonin

Анотація

Aim. Acute necrotizing pancreatitis is one of the most severe and dangerous diseases from the acute surgical pathology. There is no doubt that high lethal outcome with purulent-septic complications in the majority of cases is caused by late diagnostics, which is of a principal value in choosing therapeutic tactics. Therefore, purpose of our research was to evaluate the efficacy of procalcitonin for the early diagnosis of infectious complications of acute necrotic pancreatitis as well as for the estimation of the severity of patients’ conditions and for the prognosis of disease outcome.

Materials and methods. We performed prospective cohort study of 151 consequent patients with acute necrotic pancreatitis who were treated in one intensive care unit during 2013-2019. Severity of acute necrotizing pancreatitis was determined according to revised Atlanta classification (2012). Organ failure was defined by modified Marshall scoring system. The diagnoses of SIRS, sepsis and septic shock were made according to the criteria described by the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/ SCCM). Intervention was generally only performed in case of suspected or confirmed infection of pancreatic necrosis or peri-pancreatic necrosis alone accompanying an aggravated general condition. Microbiological investigation of biological material from necrotic collections was performed at time of intervention and every 3rd day in case draining was applied until removing of drains. Blood culture was performed in all persons at time of intervention and repeated in case of patient’s condition deterioration. Before interventional treatment, plasma samples were collected for procalcitonin determination. The plasma samples were categorized into four groups according to results of microbiological assay at time of intervention and clinical conditions of patients: SIRS without infection, local infection, sepsis and septic shock.

Results and discussion. Infections of necrotic tissue were diagnosed at 89 (55.6%) of 151 patients. Local purulent complications were established at 27 cases, sepsis – at 33, and septic shock - at 29 patients. At 62 patients with sterile acute necrotizing pancreatitis the procalcitonin concentration was higher than in healthy individuals and reached 1.34 ± 0.19 ng/ml (p>0.05). The development of purulent-septic complications was accompanied by an increase of procalcitonin concentration till 4.47 ± 0.67 ng/ml (p <0.01): in patients with sepsis to 5.05 ± 0.92 ng/ml and septic shock - up to 7.25 ± 2.15 ng/ml.

Conclusions. The concentration of procalcitonin greater than 1.84 ng/ml in the blood plasma of patients with acute necrotic pancreatitis permitted to diagnose the development of purulent-septic complications with high sensitivity and clinical specificity. The level of procalcitonin in blood plasma correlated with the severity of the patients’ conditions and the prognosis of the disease. Procalcitonin level above 4.0 ng/ml was prognostic unfavorable for the survival of patients and corresponded to 16 points of the APACHE II score (sensitivity 72.24%, specificity 78.12%).

Опубліковано
2020-07-05
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