PROCALCITONIN - A NEW MARKER FOR THE ACUT E-PHASE REACTION IN ACUTE-PANCREATITIS

Procalcitonin is a protein which is found in elevated concentrations i n the blood circulation during systemic bacterial, fungal or protozoal infection. In contrast to classical acute-phase proteins like C-react ive protein or interleukin-6, it is not elevated after operative traum a. In this paper we present current opinions on the assumed induction mechanisms of the protein by cytokines and endotoxin. Furthermore, the clinical value for early detection of systemic infections in abdomina l and transplantation surgery is demonstrated by examples from the lit erature. Our investigation shows that eight patients with necrotizing pancreatitis had a PCT mean value of 6.9 ng/ml on the day of admission . Seven patients with edematous pancreatitis had only a PCT mean value of 0.69 ng/ml. Despite these differences in the mean values, a signif icant difference between the normal value and the mean value of the gr oup with necrotizing pancreatitis or edematous pancreatitis was not ob served due to the wide range of PCT levels in the group of patients wi th necrotizing pancreatitis. The fact that only a few of the patients had a super infected necrosis with systemic evasion of bacterias or th eir toxins may be the reason for this wide range. We suggest that a di scrimination between superinfected necrotizing or sterile pancreatitis and edematous pancreatitis by PCT could be possible but more extensiv e studies with micro. biological examination of the necrotic material are required to recognize the subgroups and to establish the real diag nostic efficiency of PCT in clinical practice, especially in the predi ction of the outcome of acute pancreatitis.