PRESEPSIN LEVELS AS CRITERIA FOR EARLY ANTIBIOTIC APPLICATION IN PATIENTS WITH INFECTED ACUTE NECROTIZING PANCREATITIS
Oleksandr Rotar*1, Igor Khomiak2, Mikhail Nazarchuk3, Rotar Vasyl1, Oleksandr Rak1, Michael A. Fishbach1
1General Surgery, Bukovinian State Medical University, Chernivtsi, Ukraine; 2Shalimov National Institute of surgery and transplantology, Kyiv, Ukraine; 35th City Clinical Hospital, Minsk, Belarus
Introduction: Purulent complications worsens prognosis in patients with acute necrotizing pancreatitis (ANP). Early determination of patients with high risk of infection development permits effective application of antibacterial medications thus could improve results of treatment.
Aim: to determine presepsin level associated with subsequent development of infected complications in patients with ANP.
Material and Methods: Prospective study of 70 patients with severe ANP in a single intensive care department has been performed. Level of presepsin in patients with SIRS lasted longer than 1 week was estimated every 3rd–5th day until invasive treatment was applied. Bacteriological investigation of acquired material served as criteria for diagnosis of infected ANP. Levels of presepsin associated with infection occurrence at each period of investigation were determined by Roc analyze.
Results: The positive results of bacteriological examination were obtained in 43 patients. The rate of presepsin was significantly higher in the patients with infected complications than those in the individuals with sterile pancreatic necrosis with cut-of level above 632 pg /ml of at time of invasive procedure (0.956, p=0.001), 457 pg|/ml – within week before decision of its application (0.916, p=0.001) and 403 pg/ml (0.876, p=0.01) – in case of prolonged SIRS.
Conclusion: Presepsin level over 400 pg/ml in patients with prolonged SIRS is highly associated with subsequent development of infected complications of ANP and may serves as criterion for early application of antibacterial treatment.
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