THE CLINICAL-VALUE OF HUMAN PANCREAS-SPECIFIC PROTEIN PROCARBOXYPEPTIDASE-B AS AN INDICATOR OF NECROSIS IN ACUTE-PANCREATITIS - COMPARISON TO CRP AND LDH

Early assessment of severity in acute pancreatitis (AP) has a major im pact on further treatment. Previous studies have shown that human panc reas-specific protein (hPASP)/ procarboxypeptidase B (PCPB) is a new d iagnostic and prognostic marker in AP. In the present study we focused on the prognostic properties of this parameter and analyzed the clini cal value of hPASP in discriminating edematous from necrotizing AP. Th e results were compared to those for C-reactive protein (CRF) and lact ate dehydrogenase (LDH). A total of 70 patients was enrolled in this p rospective study. Based on contrast-enhanced computed tomography or in traoperative results, 39 patients (27 male, 12 female; median age, 42 years; median Ranson score, 6) suffered from necrotizing pancreatitis (NP) and 31 patients (12 male, 19 female, median age, 57; median Ranso n score, 1.5) from acute interstitial-edematous pancreatitis (AIP). Se rum concentrations of hPASP/PCPB, CRP, and LDH were measured at 24-h i ntervals over 14 days after admission by a radioimmunoassay (upper nor mal value, 60 ng/ ml), a lasernephelometric assay (upper normal value, 4 mg/L), and an enzymekinetic method (upper normal value, 240 U/L), r espectively. During the overall observation period concentrations of h PASP/PCPB, CRP, and LDH were significantly higher in patients with NP compared to those will AIP. Based on receiver operating characteristic s, the best cutoff levels for predicting NP were > 200 ng/ml for hPASP /PCPB, > 140 mg/L for CRP, and > 290 U/L for LDH. Discrimination betwe en AIP and NP was best on day 3 for both hPASP/PCPB (sensitivity, 91%; specificity, 64%; accuracy, 79%) and CRP (sensitivity, 83%; specifici ty, 84%; accuracy, 83%) and on day 5 of AP for LDH (sensitivity, 88%; specificity, 100%; accuracy, 91%). The overall accuracy in differentia ting AIP from NP within the first 4 days after onset of symptoms was 7 4% for hPASP/PCPB, 75% for CRP, and 76% for LDH. None of the parameter s correlated with the extent of necrosis or the etiology of AP. hPASP/ PCPB provides good discrimination between AIP and NP at an early stage of the disease, with results comparable to those for CRP and LDH. Alt hough hPASP/PCPB is both disease specific and predictive for necrosis, the clinical use of this test in its present form is limited due to d rawbacks in terms of test performance and cost factors.