Does Elevated Serum Levels of Procalcitonin Potentially Correlate with Severity of Acute Pancreatitis: A Prospective Study

Objective: Acute pancreatitis (AP) is not consistent in terms of its clinical presentation and severity. Various biochemical parameters, computerized tomography and certain scoring systems are used for this purpose and to determine the need for intensive care. Methods: In this study patients of AP, who presented with the onset of symptoms by or before 48 hours were included. Blood samples were collected for the estimation of procalcitonin (PCT) on day of admission. Chemiluminescent immunoassay (Elecsy Brahms PCT Roche Diagnostic) was used for measuring serum PCT concentration. In this study Revised Atlanta classification was used as the gold standard to stratify severity of acute pancreatitis. Results: Of the 115 patients of AP, 58.3% were male; mean age of presentation was 47 (ranged 18-90) years, 14.8% had severe pancreatitis with organ failure, 16.5% had moderately severe pancreatitis and 68.7% were acute mild pancreatitis. Death occurred in 7%. Commonest risk factor for AP was gall stone disease (53.9%) followed by alcohol (21.7%). In 14.8% of the patients, cause was idiopathic. Mean ± SD value of serum PCT for mild, moderately severe and severe pancreatitis on day of admission were 0.46 ± 1.35 ng/ml, 1.45 ± 1.21ng/ml and 2.58 ± 3.2 ng/ml respectively. Best cut off value of serum PCT was 0.42 ng/ml between mild and moderately severe pancreatitis (ROC curve (AUC):0.785 95% CI (0.691 to 0.861) p 0.0001 with 65% sensitivity and 89.9% specificity. While best cut off value of serum PCT was 0.53 ng/ml between moderately severe and acute severe pancreatitis (ROC curve (AUC):0.70% CI (0.528 to 0.842) P 0.025 with 81.3% sensitivity and 55% specificity. Conclusion: Serum PCT is potentially a simple and a reliable early biomarker in predicting the severity of AP; however require further research to confirm its accuracy. We have best cut off values that stratify AP into mild, moderately severe and severe pancreatitis with sensitivity ranges between 65% to 81.3% at day of admission.