A Comparison of Acute Physiology and Chronic Health Evaluation II Score and Serum Procalcitonin Change for Predicting Mortality in Acute Pancreatitis
Sakshi Duggal, Partha S Biswas
Acute pancreatitis, Acute physiology and chronic health evaluation II, Procalcitonin
Citation Information :
Duggal S, Biswas PS. A Comparison of Acute Physiology and Chronic Health Evaluation II Score and Serum Procalcitonin Change for Predicting Mortality in Acute Pancreatitis. Indian J Crit Care Med 2020; 24 (3):190-194.
Introduction: The prediction of mortality in acute pancreatitis (AP) is a useful estimate for effective treatment. Scoring systems such as acute physiology and chronic health evaluation (APACHE) II, computed tomography (CT) severity index (CTSI), bedside index of severity in acute pancreatitis (BISAP), etc., are used for prediction. Biomarkers like C-reactive protein (CRP) and procalcitonin (PCT) are also considered useful for prognostication. The aim of this retrospective study was to correlate the changes in serum PCT level with APACHE II score between admission and 48 hours as mortality predictor in AP. Materials and methods: The observational study was conducted in a cohort of 42 patients admitted consecutively in the seven-bedded general intensive care unit (ICU) of our institute between June 2016 and May 2018, with the diagnosis of AP. The APACHE II score and serum PCT level at admission and 48 hours were retrieved from the hospital database. The change in APACHE II and PCT level was compared between ICU “survivors” and “nonsurvivors.” The predictive accuracy of APACHE II and PCT was measured using area under receiver–operator characteristics (ROC) curve. A p value <0.05 was considered as significant. Results: Of the 42 patients enrolled, 30 patients (71.42%) were survivors and 12 (28.58%) were nonsurvivors. The median APACHE II score in nonsurvivors increased from 16 (7–19) to 23 (11–29) and remained unchanged at 16 (9–19 at admission; 10–22 at 48 hours) in survivors. The median PCT levels increased from 3.8 (1.2–5.6) to 6.2 (1.9–12.5) in nonsurvivors and decreased from 3.8 (1.2–5.6) to 2.2 (0.6–2.9) in survivors. Serum PCT change compared better than the APACHE II score change among survivors (r = 0.455, p = 0.011) with a mean (±standard deviation SD) change of 1.41 (±1.59). Conclusion: The change in serum PCT and APACHE II between admission and 48 hours correlates well and is useful for mortality prediction in AP. Serum PCT change compares better than APACHE II score change in survivors.
Halonen KI, Pettila V, Leppaniemi AK, Kemppainen EA, Puolakkainen PA, Haapianen RK. Multiple organ dysfunction associated with severe acute pancreatitis. Crit Care Med 2002;30(6):1274–1279. DOI: 10.1097/00003246-200206000-00019.
Mofidi R, Duff MD, Wigmore SJ, Madhavan KK, Garden OJ, Parks RW. Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis. Br J Surg 2006;93(6):738–744. DOI: 10.1002/bjs.5290.
Lytras D, Manes K, Triantopoulou C, Paraskeva C, Delis S, Avgerinos C, et al. Persistent early organ failure: defining the high-risk group of patients with severe acute pancreatitis? Pancreas 2008;36(3):249–254. DOI: 10.1097/MPA.0b013e31815acb2c.
Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013;62(1):102–111. DOI: 10.1136/gutjnl-2012-302779.
Mofidi R, Suttie SA, Patil PV, Ogston S, Parks RW. The value of procalcitonin at predicting the severity of acute pancreatitis and development of infected pancreatic necrosis: systematic review. Surgery 2009;146(1):72–81. DOI: 10.1016/j.surg.2009.02.013.
Wilson C, Heath DI, Imrie CW. Prediction of outcome in acute pancreatitis: a comparative study of APACHE II, clinical assessment and multiple factor scoring systems. Br J Surg 1990;77(11):1260–1264. DOI: 10.1002/bjs.1800771120.
Kuo DC, Rider AC, Estrada P, Kim D, Pillow MT. Acute pancreatitis: What’s the score? J Emerg Med 2015;48(6):762–770. DOI: 10.1016/j.jemermed.2015.02.018.
Papachristou GI, Muddana V, Yadav D, O’Connell M, Sanders MK, Slivka A, et al. Comparison of BISAP, Ranson’s, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. Am J Gastroenterol 2010;105(2):435–441. DOI: 10.1038/ajg.2009.622.
Cho JH, Kim TN, Chung HH, Kim KH. Comparison of scoring systems in predicting the severity of acute pancreatitis. World J Gastroenterol 2015;21(8):2387–2394. DOI: 10.3748/wjg.v21.i8.2387.
Park JY, Jeon TJ, Ha TH, Hwang JT, Sinn DH, Oh TH, et al. Bedside index for severity in acute pancreatitis: comparison with other scoring systems in predicting severity and organ failure. Hepatobiliary Pancreat Dis Int 2013;12(6):645–650. DOI: 10.1016/S1499-3872(13)60101-0.
Schuetz P, Christ-Crain M, Müller B. Procalcitonin and other biomarkers to improve assessment and antibiotic stewardship in infectionshope for hype? Swiss Med Wkly 2009;139(23–24):318–326.
Briel M, Schuetz P, Mueller B, Young J, Schild U, Nusbaumer C, et al. Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care. Arch Intern Med 2008;168(18):2000–2007. DOI: 10.1001/archinte.168.18.2000.
Linscheid P, Seboek D, Schaer DJ, Zulewski H, Keller U, Müller B. Expression and secretion of procalcitonin and calcitonin gene-related peptide by adherent monocytes and by macrophage-activated adipocytes. Crit Care Med 2004;32(8):1715–1721. DOI: 10.1097/01.CCM.0000134404.63292.71.
Schneider HG, Lam QT. Procalcitonin for the clinical laboratory: a review. Pathology 2007;39(4):383–390. DOI: 10.1080/00313020701444564.
Norman J, Fink GW, Denham W, Yang J, Carter G, Sexton C, et al. Tissue-specific cytokine production during experimental acute pancreatitis. A probable mechanism for distant organ dysfunction. Dig Dis Sci 1997;42(8):1783–1788. DOI: 10.1023/A:1018886120711.
Norman J, Yang J, Fink G, Carter G, Ku G, Denham W, et al. Severity and mortality of experimental pancreatitis are dependent on interleukin-1 converting enzyme (ICE). J Interferon Cytokine Res 1997;17(2):113–118. DOI: 10.1089/jir.1997.17.113.
McKay CJ, Gallagher G, Brooks B, Imrie CW, Baxter JN. Increased monocyte cytokine production in association with systemic complications in acute pancreatitis. Br J Surg 1996;83(7):919–923. DOI: 10.1002/bjs.1800830712.
Yonetci N, Sungurtekin U, Oruc N, et al. Is procalcitonin a reliable marker for the diagnosis of infected pancreatic necrosis? ANZ J Surg 2004;74(7):591–595. DOI: 10.1111/j.1445-2197.2004.03059.x.
Gross V, Andreesen R, Leser H-G, Ceska M, Liehl E, Lausen M, et al. Interleukin-8 and neutrophil activation in acute pancreatitis. Eur J Clin Invest 1992;22(3):200–203. DOI: 10.1111/j.1365-2362.1992.tb01826.x.
Pezzilli R, Billi P, Miniero R, Fiocchi M, Cappelletti O, Morselli-Labate AM, et al. Serum interleukin-6, interleukin-8, and α2-microglobulin in early assessment of severity of acute pancreatitis. Comparison with serum C-reactive protein. Dig Dis Sci 1995;40(11):2341–2348. DOI: 10.1007/BF02063235.
Zimmerman JE, Kramer AA, McNair DS, Malila FM. Acute Physiology and Chronic Health Evaluation (APACHE) IV: hospital mortality assessment for today’s critically ill patients. Crit Care Med 2006;34(5):1297–1310. DOI: 10.1097/01.CCM.0000215112.84523.F0.
Liu TH, Kwong KL, Tamm EP, Gill BS, Brown SD, Mercer DW. Acute pancreatitis in intensive care unit patients: value of clinical and radiologic prognosticators at predicting clinical course and outcome. Crit Care Med 2003;31(4):1026–1030. DOI: 10.1097/01.CCM.0000049951.77583.85.
Garcea G, Gouda M, Hebbes C, Ong SL, Neal CP, Dennison AR, et al. Predictors of severity and survival in acute pancreatitis: validation of the efficacy of early warning scores. Pancreas 2008;37(3):e54–e61. DOI: 10.1097/MPA.0b013e3181771451.
Chaloner C, Laing I, Heath DI, Imrie C, Braganza JM. Dysregulation of T cell-macrophage network in severe acute pancreatitis. Biochem Soc Transact 1993;21(4):451. DOI: 10.1042/bst021451s.
Curley P, McMahon RF, Lancaster F, Banks RE, Barclay GR, Shefta J, et al. Reduction in circulating levels of CD4-positive lymphocytes in acute pancreatitis: relationship to endotoxin, interleukin 6 and disease severity. Br J Surg 1993;80(10):1312–1315. DOI: 10.1002/bjs.1800801031.
Uhl W, Buechler M, Malfertheiner P, Martini M, Beger HG. PMN-elastase in comparison with CRP, antiproteases and LDH as indicators of necrosis in human acute pancreatitis. Pancreas 1991;6(3):253–259. DOI: 10.1097/00006676-199105000-00001.