The Preliminary Discussion of The Effect of PCT on Severe Acute Pancreatitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LIMao ,  HUWei-ming , CHENYang , LIAng , LUHui-min

;

Corresponding?author：

HUWei-ming, Email: huweiming64@163.com

Keywords：

Severe acute pancreatitis; Procalcitonin; Operating time; Postoperative complication

DOI：

10.7507/1007-9424.20150008

Video：

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Objectives To identify the effect of procalcitonin (PCT) on the choice of operating time for severe acute pancreatitis and assessment of postoperative complications by monitoring the level of serum PCT and recording the incidence of postoperative complications. Methods Ninety-three patients who underwent debridement and drainage of infected necrosis from Sep. 2009 to Dec. 2011 were included. Serum PCT was tested on the day of admission (0 day), one week after admission, one day before surgery, one day after surgery, and one week after surgery. According to the level of serum PCT, all the 93 patients were divided into 3 groups:low level group (PCT < 2 ng/mL), middle level group (PCT 2-10 ng/mL), and high level group (PCT > 0 ng/mL). Postoperative complications were also recorded. Results The incidence of postoperative complications was 19.4% (18/93). There were postoperative bleeding in 13 patients, intestinal fistula in 14 patients, pancreatic fistula in 18 patients, pulmonary infection in 4 patients, residual abscess in 10 patients; re-operation in 15 patients, and death in 8 patients (the death rate was 8.6%). Besides the pulmonary infection, and grade A and C of pancreatic fistula, the incidence of various complications in middle level group and high level group were lower than low level group (P < 0.05). Patients with complications had significantly higher PCT value in one week after admission than onset (P < 0.05). PCT value was higher in the patients with intestinal fistula and residual abscess on one day after operation than on one day before operation (P < 0.05). Patients who died or with re-operation had significantly higher PCT value in one week after operation than on one day after operation (P < 0.05). In the dead patients, the serum PCT sustained at a high level after operation. Conclusions The level of serum PCT is correlated with the incidence of postoperative complications. Dynamic monitoring the level of serum PCT can guide the choice of operative time and assessment of postoperative complications including intestinal fistula, pulmonary infection, and death, which can greatly improve the prognosis of SAP.

Citation： LIMao, HUWei-ming, CHENYang, LIAng, LUHui-min. The Preliminary Discussion of The Effect of PCT on Severe Acute Pancreatitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(1): 28-32. doi: 10.7507/1007-9424.20150008 Copy

1.	Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis-2012:revision of the Atlanta classification and definitions by international consensus. Gut, 2013, 62(1):102-111.
2.	中華醫學會消化病學分會胰腺疾病學組, 中華胰腺病雜志編輯委員會, 中華消化雜志編輯委員會.中國急性胰腺炎診治指南(2013, 上海).中華消化雜志, 2013, 33(4):217-222.
3.	Whitcomb DC. Clinical practice. Acute pancreatitis. N Engl J Med, 2006, 354(20):2142-2150.
4.	Wenzel RP. Anti-endotoxin monoclonal antibodies:a second look. N Engl J Med, 1992, 326(17):1151-1153.
5.	Russwurm S, Wiederhold M, Oberhofer M. Molecular aspects and natural source of procaleitonin. Clin Chem Lab Med, 1999, 37(8):789-797.
6.	Banks PA, Freeman ML, Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol, 2006, 101(10):2379-2400.
7.	耿小平.重癥急性胰腺炎手術指征與時機探討.肝膽外科雜志, 2007, 15(1):3-6.
8.	Wemer J, Hartwig W, Hackert T, et al. Surgery in the treatment of acute pancreatitis-open pancreatic necrosectomy. Scand J Surg, 2005, 94(2):130-134.
9.	Wemer J, Uhl W, Hartwig W, et al. Modern phase-specific management of acute pancreatitis. Dig Dis, 2003, 21(1):38-45.
10.	Mier J, León EL, Castillo A, et al. Early versus late necrosectomy in severe necrotizing pancreatitis. Am J Surg, 1997, 173(2):71-75.
11.	Besselink MG, Verwer TJ, Schoenmaeckers EJ, et al. Timing of surgical intervention in necrotizing pancreatitis. Arch Surg, 2007, 142(12):1194-1201.
12.	Rodriguez JR, Razo AO, Targarona J, et al. Debridement and closed packing for sterile or infected necrotizing pancreatitis:insights into indications and outcomes in 167 patients. Ann Surg, 2008, 247(2):294-299.
13.	van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology, 2011, 141(4):1254-1263.
14.	Chiwakata CB, Manegold C, B?nicke L, et al. Procalcitonin as a parameter of disease severity and risk of mortality in patients with plasmodium falciparum malaria. J Infect Dis, 2001, 183(7):1161-1164.
15.	中華醫學會消化病學分會胰腺疾病學組.中國急性胰腺炎診治指南.中華消化雜志, 2004, 24(3):190-192.
16.	Marshall JC, Cook DJ, Christou NV, et al. Multiple organ dysfunction score:a reliable descriptor of a complex clinical outcome. Crit Care Med, 1995, 23(10):1638-1652.
17.	Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology, 2013, 13(4 Suppl 2):e1-e15.
18.	中華醫學會外科學分會胰腺外科學組.中國胰腺術后外科常見并發癥預防及治療的專家共識.中華外科雜志, 2010, 48(18):1365-1368.
19.	Ghillani PP, Motté P, Troalen F, et al. Identification and measure ment of calcitonin Precursors in serum of patients with malignant diseases. Cancer Res, 1989, 49(23):6845-6851.
20.	Whicher J, Bienvenu J, Monneret G. Procalcitonin as an acute phase marker. Ann Clin Biochem, 2001, 38(5):483-493.
21.	劉琦, 郭艷茹, 劉瑩等.降鈣素原抗原的表達及其抗體的制備與初步鑒定.細胞與分子免疫學雜志, 2008, 24(8):795-797.
22.	Russwurm S, Wiederhold M, Oberhoffer M, et al. Procalcitonin as monocytic marker for early diagnosis in septic abortion. Z Geburtshilfe Neonatol, 2000, 204(1):34-38.
23.	Wrenger S, K?hne T, Bohuon C, et al. Amino-terminal truncation of procalcitonin, a marker for systemic bacterial infections, by dipeptidyl peptidaseⅣ(DPⅣ). FEBS Lett, 2000, 466(1):155-159.
24.	Monneret G, Labaune JM, Isaac C, et al. Procalcitonin and C-reactive protein levels in neonatal infections. Acta Paediatr, 1997, 86(2):209-212.
25.	Rau B, Steinbach G, Gansauge F, et al. The potential role of procalctionin and interleukin 8 in the prediction of infected necrosis in acute pancreatitis. Gut, 1997, 41(6):832-840.
26.	Makay R, Issekutz A, Banga P. et al. Role of procalctionin rapid test in the differential diagnosis of uninfected and infected forms of acute pancreatitis. Magy Seb, 2003, 56(1):31-33.
27.	石磊.降鈣素原水平在急性胰腺炎并感染中的價值.中國實用醫藥, 2011, 6(15):146-147.
28.	嚴律南, 劉續寶.重癥胰腺炎手術并發癥的防治.中華肝膽外科雜志, 2004, 10(8):508-510.
29.	施益九, 宋甫春.急性重癥胰腺炎術后并發癥臨床分析.現代實用醫學, 2008, 20(2):105-106.

1. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis-2012:revision of the Atlanta classification and definitions by international consensus. Gut, 2013, 62(1):102-111.
2. 中華醫學會消化病學分會胰腺疾病學組, 中華胰腺病雜志編輯委員會, 中華消化雜志編輯委員會.中國急性胰腺炎診治指南(2013, 上海).中華消化雜志, 2013, 33(4):217-222.
3. Whitcomb DC. Clinical practice. Acute pancreatitis. N Engl J Med, 2006, 354(20):2142-2150.
4. Wenzel RP. Anti-endotoxin monoclonal antibodies:a second look. N Engl J Med, 1992, 326(17):1151-1153.
5. Russwurm S, Wiederhold M, Oberhofer M. Molecular aspects and natural source of procaleitonin. Clin Chem Lab Med, 1999, 37(8):789-797.
6. Banks PA, Freeman ML, Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol, 2006, 101(10):2379-2400.
7. 耿小平.重癥急性胰腺炎手術指征與時機探討.肝膽外科雜志, 2007, 15(1):3-6.
8. Wemer J, Hartwig W, Hackert T, et al. Surgery in the treatment of acute pancreatitis-open pancreatic necrosectomy. Scand J Surg, 2005, 94(2):130-134.
9. Wemer J, Uhl W, Hartwig W, et al. Modern phase-specific management of acute pancreatitis. Dig Dis, 2003, 21(1):38-45.
10. Mier J, León EL, Castillo A, et al. Early versus late necrosectomy in severe necrotizing pancreatitis. Am J Surg, 1997, 173(2):71-75.
11. Besselink MG, Verwer TJ, Schoenmaeckers EJ, et al. Timing of surgical intervention in necrotizing pancreatitis. Arch Surg, 2007, 142(12):1194-1201.
12. Rodriguez JR, Razo AO, Targarona J, et al. Debridement and closed packing for sterile or infected necrotizing pancreatitis:insights into indications and outcomes in 167 patients. Ann Surg, 2008, 247(2):294-299.
13. van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology, 2011, 141(4):1254-1263.
14. Chiwakata CB, Manegold C, B?nicke L, et al. Procalcitonin as a parameter of disease severity and risk of mortality in patients with plasmodium falciparum malaria. J Infect Dis, 2001, 183(7):1161-1164.
15. 中華醫學會消化病學分會胰腺疾病學組.中國急性胰腺炎診治指南.中華消化雜志, 2004, 24(3):190-192.
16. Marshall JC, Cook DJ, Christou NV, et al. Multiple organ dysfunction score:a reliable descriptor of a complex clinical outcome. Crit Care Med, 1995, 23(10):1638-1652.
17. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology, 2013, 13(4 Suppl 2):e1-e15.
18. 中華醫學會外科學分會胰腺外科學組.中國胰腺術后外科常見并發癥預防及治療的專家共識.中華外科雜志, 2010, 48(18):1365-1368.
19. Ghillani PP, Motté P, Troalen F, et al. Identification and measure ment of calcitonin Precursors in serum of patients with malignant diseases. Cancer Res, 1989, 49(23):6845-6851.
20. Whicher J, Bienvenu J, Monneret G. Procalcitonin as an acute phase marker. Ann Clin Biochem, 2001, 38(5):483-493.
21. 劉琦, 郭艷茹, 劉瑩等.降鈣素原抗原的表達及其抗體的制備與初步鑒定.細胞與分子免疫學雜志, 2008, 24(8):795-797.
22. Russwurm S, Wiederhold M, Oberhoffer M, et al. Procalcitonin as monocytic marker for early diagnosis in septic abortion. Z Geburtshilfe Neonatol, 2000, 204(1):34-38.
23. Wrenger S, K?hne T, Bohuon C, et al. Amino-terminal truncation of procalcitonin, a marker for systemic bacterial infections, by dipeptidyl peptidaseⅣ(DPⅣ). FEBS Lett, 2000, 466(1):155-159.
24. Monneret G, Labaune JM, Isaac C, et al. Procalcitonin and C-reactive protein levels in neonatal infections. Acta Paediatr, 1997, 86(2):209-212.
25. Rau B, Steinbach G, Gansauge F, et al. The potential role of procalctionin and interleukin 8 in the prediction of infected necrosis in acute pancreatitis. Gut, 1997, 41(6):832-840.
26. Makay R, Issekutz A, Banga P. et al. Role of procalctionin rapid test in the differential diagnosis of uninfected and infected forms of acute pancreatitis. Magy Seb, 2003, 56(1):31-33.
27. 石磊.降鈣素原水平在急性胰腺炎并感染中的價值.中國實用醫藥, 2011, 6(15):146-147.
28. 嚴律南, 劉續寶.重癥胰腺炎手術并發癥的防治.中華肝膽外科雜志, 2004, 10(8):508-510.
29. 施益九, 宋甫春.急性重癥胰腺炎術后并發癥臨床分析.現代實用醫學, 2008, 20(2):105-106.

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The Preliminary Discussion of The Effect of PCT on Severe Acute Pancreatitis

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