Comparison of Serum Procalcitonin with Ranson, APACHE-II, Glasgow and Balthazar CT Severity Index Scores in Predicting Severity of Acute Pancreatitis

Su Mi Woo; Myung Hwan Noh; Byung Geun Kim; Chien Ter Hsing; Ji Sun Han; Seung Hee Ryu; Jeong Min Seo; Hyun Ah Yoon; Jin Seok Jang; Seok Reyol Choi; Jin Han Cho

doi:10.4166/kjg.2011.58.1.31

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Woo, Noh, Kim, Hsing, Han, Ryu, Seo, Yoon, Jang, Choi, and Cho: Comparison of Serum Procalcitonin with Ranson, APACHE-II, Glasgow and Balthazar CT Severity Index Scores in Predicting Severity of Acute Pancreatitis

Original Article

Korean J Gastroenterol 2011;58(1):31-37.

Published online: 4 October 2011

DOI: https://doi.org/10.4166/kjg.2011.58.1.31

Comparison of Serum Procalcitonin with Ranson, APACHE-II, Glasgow and Balthazar CT Severity Index Scores in Predicting Severity of Acute Pancreatitis

Su Mi Woo, Myung Hwan Noh, Byung Geun Kim, Chien Ter Hsing, Ji Sun Han, Seung Hee Ryu, Jeong Min Seo, Hyun Ah Yoon, Jin Seok Jang, Seok Reyol Choi, Jin Han Cho¹

Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea

¹Department of Radiology, Dong-A University College of Medicine, Busan, Korea

Correspondence to: Myung Hwan Noh, Division of Gastroenterology, Department of Internal Medicine, Dong-A University College of Medicine, 3-1, Dongdaeshin-dong, Seo-gu, Busan 602-715, Korea. Tel: +82-51-240-2862, Fax: +82-51-242-5852, E-mail: mhnho@dau.ac.kr

Received 8 January 201114 April 2011 Accepted 9 May 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

The aim of this study is to assess serum procalcitonin (PCT) for early prediction of severe acute pancreatitis compared with multiple scoring systems and biomarkers.

Methods

Forty-four patients with acute pancreatitis confirmed by radiological evidences, laboratory assessments, and clinical manifestation were prospectively enrolled. All blood samples and image studies were obtained within 24 hours of admission.

Results

Acute pancreatitis was graded as severe in 19 patients and mild in 25 patients according to the Atlanta criteria. Levels of serum PCT were significantly higher in severe acute pancreatitis (p=0.001). The accuracy of serum PCT as a predicting marker was 77.3%, which was similar to the acute physiology and chronic health examination (APACHE)-II score, worse than the Ranson score (93.2%) and better than the Balthazar CT index (65.9%). The most effective cutoff level of serum PCT was estimated at 1.77 ng/mL (AUC=0.797, 95% CI=0.658-0.935). In comparision to other simple biomarkers, serum PCT had more accurate value (77.3%) than C-reactive protein (68.2%), urea (75.0%) and lactic dehydrogenase (72.7%). Logistic regression analysis revealed that serum PCT has statistical significance in acute severe pancreatitis. Assessment of serum PCT levels and length of hospital stay by simple linear regression analysis revealed effective p-value with low R square level, which could make only possibilty for affection of serum PCT to admission duration (r2=0.127, p=0.021).

Conclusions

Serum PCT was a promising simple biomarker and had similar accuracy of APACHE-II scores as predicting severity of acute pancreatitis.

Keywords: Serum procalcitonin, Acute necrotizing pancreatitis, Multiple scoring systems

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Fig. 1.

Mean value of serum levels of procalcitonin in mild and severe acute pancreatitis clossified by Atlanta criteria. Levels of serum procalcitonin were significantly higher in severe acute pancreatitis. Md, mild acute pancreatitis (n=25, SD=4.614); Severe, severe acute pancreatitis (n=24, SD= 53.433). ∗Mann-Whitney U test, p=0.001.

Fig. 2.

Receiver operation characteristic curve of serum levels of procalcitonin in prediction of severity of acute pancreatitis. Numbers of observation=44. AUC, area under curve.

Fig. 3.

Correlation between serum procalcitonin levels and duration of admission in patients with acute pancreatitis. Procalcitonin is indendent variable (x), admission duration is dependent variable (y). Coefficient B is −8.791. Coefficient of determinant (r2)=0.127, t value=2.413, dependent p-value=0.021.

Table 1.

Characteristics of Patients with Acute Pancreatitis

	Mild pancreatitis (n=25)	Severe pancreatitis (n=19)	Total (n=44)	p-value
Men/Women	17/8	11/8	28/16	0.490
Age (yr); median (range)	55 (22–89)	66 (39–79)	61.5 (22–89)	0.061
Death	0	4	4	0.029
Duration of admission (days); median (range)	11.5 (6–35)	20 (2–40)	14.5 (2–40)	0.147
Etiology				0.465
Alcoholic	10	9	19
Biliary	8	3	11
Idiopathic and miscellaneous	7	7	14
Scoring system and biochemical markers: medi	an (range)
APACHE II score	4 (0–8)	11 (2–19)	6 (0–19)	<0.001
Ranson score	2 (0–5)	4 (2–9)	2 (0–9)	<0.001
Glasgow score	1 (0–4)	3 (1–7)	2 (0–7)	<0.001
BCTSI	2 (0–4)	3 (1–10)	2 (0–10)	0.024
PCT (ng/mL)	0.43 (0.01-18.82)	4.28 (0.01-166.69)	1.66 (0.01-166.69)	0.001
CRP (mg/dL)	3.69 (0.03-42.91)	11.73 (0.79-44.08)	7.9 (0.03-44.08)	0.015
Total calcium (mg/dL)	8.6 (4.1-11)	8.2 (3.9-11.1)	8.6 (3.9-11.1)	0.380
LDH (IU/L)	432 (155–2047)	645 (279–3321)	550 (155–3321)	0.014
Glucose (mg/dL)	128 (89–316)	157 (89–567)	138.5 (89–567)	0.112
Urea (mg/dL)	16 (5–75)	28 (6–220)	19 (5–220)	0.011

APACHE, acute physiology and chronic health examination; BCTSI, balthazar CT severity index; PCT, procalcitonin.

Table 2.

Analysis of Acute Pancreatitis Parameters

Parameters	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	Accuracy (%)	Likelihood ratio
APACHE II score ≥7	78.9	76	71.4	82.6	77.3	13.795
Ranson score ≥3	89.5	96	94.4	92.3	93.2	38.35
Glasgow score ≥3	63.2	92	85.7	76.7	79.6	16.097
BCTSI ≥4	42.1	84	66.7	65.6	65.9	3.716
PCT (ng/mL) ≥1.77	78.9	76	71.4	82.6	77.3	13.795
CRP (mg/dL) ≥8.2	68.4	68	61.9	73.9	68.2	5.864
Total-calcium (mg/dL) ≥9.40	31.6	76	50	59.4	56.8	0.311
LDH (IU/L) ≥453	94.7	56	62	93.3	72.7	14.332
Glucose (mg/dL) ≥140	63.2	60	54.6	68.2	61.4	2.338
Urea (mg/dL) ≥20	73.7	76	70	79.2	75	9.358

APACHE, acute physiology and chronic health examination; BCTSI, balthazar CT severity index; PCT, procalcitonin; PPV, positive predictive value; NPV, negative predictive value.

Table 3.

Serum Procalcitonin in Prediction of Severe Acute Pancreatitis

Cutoff value (ng/mL)	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	Accuracy (%)	Likelihood ratio
0.50	89.5	56	60.71	87.5	70.5	10.599
1.00	84.2	64	64	84.2	72.7	10.931
1.77	78.9	76	71.4	82.6	77.3	13.795
2.65	68.4	76	68.4	76	72.7	8.923

PPV, positive predictive value; NPV, negative predictive value.

Table 4.

Logistic Regression Analysis of Risk Factors for Severe Acute Pancreatitis

	B	Odds ratio	p-value	95% confidence Interval
	B	Odds ratio	p-value	Upper	Lower
Sex	0.435	1.545	0.491	0.448	5.336
APACHE II score ≥7	2.474	11.875	0.001	2.828	49.865
Ranson score ≥3	5.318	204	<0.001	17.091	2434.945
Glasgow score ≥3	2.981	19.714	<0.001	3.532	110.039
BCTSI ≥4	1.340	3.818	0.062	0.937	15.554
PCT ≥1.77	2.474	11.875	0.001	2.828	49.865
CRP (mg/dL) ≥8.2	1.527	4.604	0.02	1.278	16.582
Total calcium (mg/dL) ≥9.04	0.379	1.462	0.577	0.385	5.545
LDH (IU/L) ≥453	3.132	22.909	0.005	2.634	199.241
Glucose (mg/dL) ≥140	0.994	2.571	0.132	0.753	8.784
Urea (mg/dL) ≥20	2.182	8.867	0.002	2.246	34.998

APACHE, acute physiology and chronic health examination; BCTSI, balthazar CT severity index; PCT, procalcitonin.

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