Role of procalcitonin in diagnosis and treatment of acute pancreatitis

Acute pancreatitis (AP) is a common disease with a wide range of presentations. Several scoring systems, such as Ranson and Acute Physiology and Chronic Health Evaluation (APACHE) II were established to predict the severity of acute pancreatitis with acceptable sensitivity and specificity, but they are predominantly designed to predict ICU mortality. The progression to severe pancreatitis is associated with development of a systemic inflammatory response syndrome. In addition, a variety of acute phase reactants, cytokines, chemokines, and other markers of the inflammatory response have been evaluated as predictors of severe AP, as well as markers of development of specific organ-system failure. C-reactive protein is the most commonly used single severity marker of AP but the sensitivity, specificity, and predictive values for CRP were lower than those for procalcitonin. For over a decade, serum PCT has been available as early predictor of development of local complication, severity and organ failure in patients with acute pancreatitis. Recent metaanalysis have proved PCT as good predictor of either of SAP or as a predictor of development of infected pancreatic necrosis. Different citokines, chemokines and their antagonists including: TNF-α, sTNFR, IL-1, IL1-RA, IL-6, IL-8, MCP-1 and MIF might be used as a biomarker of disease severity in AP. Recently, most promising results coming from animal model studies considering measurements of specific pancreatic micro RNA (miR-216a) as a good biomarker for pancreatic injury. Future clinical assessments in humans are warranted to test its feasibility in patients. We may conclude that large, prospective studies are needed to identify ideal serum biomarkers of identifying AP and predicting the disease severity.