Samanta Jayanta, Dhar Jahnvi, Birda Chhagan Lal, Gupta Pankaj, Yadav Thakur Deen, Gupta Vikas, Sinha Saroj Kant, Kochhar Rakesh
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.
Dig Dis Sci. 2023 May;68(5):2080-2089. doi: 10.1007/s10620-022-07758-4. Epub 2022 Dec 2.
Timely intervention can alter outcome in patients of infected pancreatic necrosis (IPN) but lacks adequate biomarker. Role of serum procalcitonin (PCT) in the management of IPN is understudied, and hence, this study was planned.
All patients of acute pancreatitis with IPN without prior intervention were included. Baseline demographic, radiological and laboratory parameters were documented. PCT was measured at baseline, prior to intervention, and thereafter every 72 h. Patients were grouped into those having baseline PCT < 1.0 ng/mL and those with PCT ≥ 1.0 ng/mL and various outcome measures were compared.
Of the 242 patients screened, 103 cases (66 males; 64.1%) with IPN were grouped into 2: PCT < 1.0 ng/mL (n = 29) and PCT ≥ 1.0 ng/mL (n = 74). Patients with baseline PCT ≥ 1.0 ng/mL had significantly more severe disease scores. 16 out of 19 patients with rise in PCT on day-7 post-intervention expired. PCT ≥ 1.0 ng/mL group had higher need for ICU (p = 0.001) and mortality (p = 0.044). PCT > 2.25 ng/mL (aOR 22.56; p = 0.013) at baseline and failure in reduction of PCT levels to < 60% of baseline at day-7 post-intervention (aOR 53.76; p = 0.001) were significant mortality predictors.
Baseline PCT > 1.0 ng/mL is associated with poor outcome. PCT > 2.25 ng/mL and failure in reduction of PCT levels to < 60% of its baseline at day-7 post-intervention can identify high-mortality risk patients.
及时干预可改变感染性胰腺坏死（IPN）患者的预后，但缺乏足够的生物标志物。血清降钙素原（PCT）在IPN管理中的作用研究不足，因此开展了本研究。
纳入所有未经预先干预的急性胰腺炎合并IPN患者。记录基线人口统计学、影像学和实验室参数。在基线、干预前及此后每72小时测量PCT。患者分为基线PCT＜1.0 ng/mL组和PCT≥1.0 ng/mL组，并比较各项预后指标。
在筛查的242例患者中，103例IPN患者（66例男性；64.1%）分为两组：PCT＜1.0 ng/mL组（n = 29）和PCT≥1.0 ng/mL组（n = 74）。基线PCT≥1.0 ng/mL的患者疾病严重程度评分显著更高。干预后第7天PCT升高的19例患者中有16例死亡。PCT≥1.0 ng/mL组对重症监护病房的需求更高（p = 0.001），死亡率也更高（p = 0.044）。基线时PCT＞2.25 ng/mL（调整后比值比22.56；p = 0.013）以及干预后第7天PCT水平未降至基线的60%以下（调整后比值比53.76；p = 0.001）是显著的死亡预测因素。
基线PCT＞1.0 ng/mL与预后不良相关。PCT＞2.25 ng/mL以及干预后第7天PCT水平未降至基线的60%以下可识别高死亡风险患者。
