PROCALCITONIN: LABORATORY DIAGNOSTIC MARKER OF PURULENT-SEPTIC COMPLICA-TIONS OF ACUTE NECROTIC PANCREATITIS

Aim. Acute necrotizing pancreatitis is one of the most severe and dangerous diseases from the acute surgical pathology. There is no doubt that high lethal outcome with purulent-septic complications in the majority of cases is caused by late diagnostics, which is of a principal value in choosing therapeutic tactics. Therefore, purpose of our research was to evaluate the efficacy of procalcitonin for the early diagnosis of infectious complications of acute necrotic pancreatitis as well as for the estimation of the severity of patients' conditions and for the prognosis of disease outcome. Materials and methods. We performed pro-spective cohort study of 151 consequent patients with acute necrotic pancreatitis who were treated in one inten-sive care unit during 2013-2019. Severity of acute ne-crotizing pancreatitis was determined according to re-vised Atlanta classification (2012). Organ failure was defined by modified Marshall scoring system. The diag-noses of SIRS, sepsis and septic shock were made ac-cording to the criteria described by the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/ SCCM). Intervention was generally only per-formed in case of suspected or confirmed infection of pancreatic necrosis or peri-pancreatic necrosis alone accompanying an aggravated general condition. Microbi-ological investigation of biological material from necrotic collections was performed at time of intervention and every 3rd day in case draining was applied until removing of drains. Blood culture was performed in all persons at time of intervention and repeated in case of patient's condition deterioration. Before interventional treatment, plasma samples were collected for procalcitonin determi-nation. The plasma samples were categorized into four groups according to results of microbiological assay at time of intervention and clinical conditions of patients: SIRS without infection, local infection, sepsis and septic shock. Results and discussion. Infections of necrotic tissue were diagnosed at 89 (55.6%) of 151 patients. Local purulent complications were established at 27 cases, sepsis – at 33, and septic shock - at 29 patients. At 62 patients with sterile acute necrotizing pancreatitis the procalcitonin concentration was higher than in healthy individuals and reached 1.34 ± 0.19 ng/ml (p>0.05). The development of purulent-septic complications was ac-companied by an increase of procalcitonin concentration till 4.47 ± 0.67 ng/ml (p <0.01): in patients with sepsis to 5.05 ± 0.92 ng/ml and septic shock - up to 7.25 ± 2.15 ng/ml. Conclusions. The concentration of procalcitonin greater than 1.84 ng/ml in the blood plasma of patients with acute necrotic pancreatitis permitted to diagnose the development of purulent-septic complications with high sensitivity and clinical specificity. The level of procalci-tonin in blood plasma correlated with the severity of the patients' conditions and the prognosis of the disease. Procalcitonin level above 4.0 ng/ml was prognostic unfa-vorable for the survival of patients and corresponded to 16 points of the APACHE II score (sensitivity 72.24%, specificity 78.12%).