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UTILITY OF PRESEPSIN AND PROCALCITONIN FOR INFECTION DIAGNOSIS DURING ACUTE NECROTIZING PANCREATITIS
Igor Khomiak*2, Oleksandr Rotar1,2, Gregory Petrovsky3, Mikhail Nazarchuk3, Vasyl Rotar1, Andrii Khomiak2
1General Surgery, Bukovinian State Medical University, Chernivtsi, Ukraine; 2Department of Pancreas Surgery and Bile Ducts Reconstruction Surgery, A. A.Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine; 35th City Hospital, Minsk, Belarus
Introduction: Purulent complications worsen prognosis in patients with acute necrotizing pancreatitis (ANP). Early prognosis and diagnosis of infection development can improve results of its management.
Aims: To establish utility of presepsin (PSP) and procalcitonin (PCT) for diagnosis of local and system infections during ANP.
Method: Prospective study of 70 patients with severe ANP in a single intensive care department of regional hospital has been performed. Levels of PSP and PCT at admission and during treatment were determined and compared with results of bacteriological investigation of pancreatic tissue as well as with APACHE II score, complications and mortality rates.
Results: In healthy individuals plasma PSP concentration was 184 ± 16 pg/ml, range fluctuated from 98 pg/mL to 218 pg/ml. In patients with ANP without infection, but with signs of SIRS, the concentration of the PSP increased to 332 ± 38 pg / ml, only 78% (p<0,05) higher than level of healthy individuals. The presence of infection was accompanied by 3,7 fold increase of its value. There was a strong PSP concentration dependence on severity of infection. Its level increased in case of local infection up to 677±30 pg/ml, sepsis - 988±47 pg/ml and severe sepsis - 2668±102 pg/ml. PSP ROC AUC value for all types of infection complications of ANP reached 0,956 (p<0,001) which was 21% higher than ROC AUC of PCT. Besides, there were only slight nonsignificant changes of PCT concentrations during the early stages of infection until it was local, whereas PSP level doubled. In such kind of patients AUC ROC for PCT was only 0,665 ± 0,10, but for PSP reached 0,927 ± 0,02 (h<0?05). We found strong correlation between the concentration of PSP and APACHE II score. ROC-analysis revealed that diagnostic accuracy of patients survival rate determination with sepsis by PSP level and APACHE II score were virtually identical: AUC ROC for presepsin was 0,886 ± 0,046 and for APACHE II - 0,952 ± 0,023.
Conclusions: PSP concentration is early highly sensitive and specific marker for all kind of purulent-septic complication during ANP and exceeds diagnostic utility of PCT. Dynamic of PSP changes allows to estimate efficacy and prognosis of ANP treatment.
Presepsin and Procalcitonin Level in Healthy Persons and Patients with Acute Necrotizing Pancreatitis
| Patients groups | Presepsin, pg/ml | Procalcitonin,ng/ml | | Conditionally healthy persons (n-10) | 184±16 | 0,14±0,07 | Patients without infection (n-21)
| 332±38 | 1,26±0,19 | | Patients with local infection (n-15) | 677±30⃰⃰ | 2,08±0,56 | | Patients with sepsis (n-22) | 988±47⃰ | 5,05±0,92⃰ | | Patients with septic shock (n-12) | 2668±483⃰ | 7,25±2,15⃰ |
* - p<0,05 in comparison with patients without infection
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