Can serum procalcitonin be a reliable single biomarker in predicting the severity of acute pancreatitis

Acute pancreatitis has always been a clinical challenge. Timely assessment of severity in patients with acute pancreatitis is of prime importance in guiding an optimal management for these patients. Over the years, a number of single and multiparameter predictors have been identified and tested for assessing the severity of this disease. The main aim of this study was to test the reliability of serum procalcitonin (PCT), a marker of systemic inflammation, as an effective single biomarker in determining the severity of acute pancreatitis early in the disease process. We conducted a retrospective study on 166 patients who were categorized into two groups of mild versus severe acute pancreatitis based on the Glasgow scoring system. The value of PCT as a prognostic marker was obtained at the time of admission and compared with other biochemical markers such as haematocrit and white blood cell count. Out of 166 patients, 30 were graded as severe and the rest (136 patients) were graded as mild cases of acute pancreatitis according to the modified Glasgow criteria. In predicting severity of acute pancreatitis at the time of admission, sensitivity and specificity of serum PCT were 60% and 82%, respectively. In the setting of computerized tomography (CT) scan, a finding of severe acute pancreatitis (acute necrotic collection/acute necrotizing pancreatitis) corresponded to serum PCT of 62% sensitivity and 71% specificity and Glasgow score of 54% sensitivity and 83% specificity. There was a moderate degree of positive correlation between PCT and length of hospital stay. The association between PCT and intensive care unit (ICU) admissions is considered to be extremely statistically significant with P<0.0001. Serum measurements of PCT may be valuable in predicting the severity of acute pancreatitis early in the disease process.