Procalcitonin, soluble interleukin-2 receptor, and soluble E-selectin in predicting the severity of acute pancreatitis

Objective: To investigate whether marker(s) of systemic inflammation detect , at an early stage of acute pancreatitis, patients who may ultimately deve lop severe disease. Design: Prospective study. Setting: University hospital emergency unit. Patients: Thirty patients with mild acute pancreatitis (SEV0 group) and 27 with severe acute pancreatitis. Of the latter, 11 did not develop organ fai lure (SEV1 group), whereas the other 16 patients developed acute respirator y failure and 9 of them also developed renal failure (SEV2 group). Interventions: Blood samples were collected at admission to the hospital (T -0), and at 12 hrs (T-12) and 24 hrs (T-24) after admission. Measurements and Main Results: The plasma concentrations of procalcitonin ( PCT), soluble E-selectin (sE-selectin), soluble interleukin-2 receptor (sIL -2R), and the serum concentration of C-reactive protein (CRP) were monitore d. PCT levels at T-0 were significantly higher in the SEV1 group (median 0. 4 ng/mL, range 0.2-2.3) and the SEV2 group (0.8 ng/mL, 0.2-73.5) than in th e SEV0 group (0.3 ng/mL, 0.1-3, p < .05 and p < .001, respectively). At T-1 2, PCT level in the SEV2 group was significantly higher than that in the SE V1 group (2.2 ng/mL, 0.2-86.6 vs. 0.4 ng/mL, 0.3-2.8, p = .05), as it also was at T-24 (2.2 ng/mL, 0.4-73.3 vs. 0.5 ng/mL, 0.3-4, p < .01). Among SEV2 patients, PCT concentration correlated negatively with the time elapsed be tween admission and the diagnosis of organ failure. At T-12, sIL-2R levels of the SEV1 group (1011 U/mL, range 334-2211) and the SEV2 group (1495 U/ml , range 514-4526) both differed significantly from the SEV0 group (636 U/ml , range 356-1678, p < .05 and p < .001, respectively) as they also did at T -24. Although CRP level in the SEV1 group at T-12 did not differ from the S EV0 group, the difference between SEV2 (272 <mu>g/mL, range 46-462) and SEV 0 was significant (53 mug/mL, range 5-243, p < 0.01). sE-selectin levels di d not differ between groups. Conclusions: At admission to hospital, concentrations of PCT, but not those of CRP, sE-selectin, or sIL-2R, are higher in patients with severe acute p ancreatitis than in patients with mild pancreatitis. PCT test had sensitivi ty of 94% and specificity of 73% for development of organ failure. PCT may be useful to identify the patients who benefit from novel therapies aimed a t modifying the course of systemic inflammation.