Diagnostic relevance of procalcitonin, IL-6, and sICAM-1 in the prediction of infected necrosis in acute pancreatitis

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Abstract

Background. Infected pancreatic necrosis (IPN) is an absolute indication for surgical intervention, therefore an early and accurate laboratory diagnosis is necessary to confirm the infection. The aim of the study was to analyze the clinical value of procalcitonin (PCT) for the prediction of infected necrosis, in comparison with interleukin-6 (IL-6) and sICAM-1. Patients and Methods. A total of 30 patients were investigated; 10 patients with sterile pancreatic necrosis (SPN), 10 with IPN, and 10 with sepsis of different origin. The concentrations of PCT in the patients' sera were measured by immunoluminometric assay (BRAHMS Diagnostica, Berlin, Germany, PCT Lumitest), the IL-6 concentrations by bioassay, applying the B-9 cell line, and the sICAM-1 levels by enzyme-linked immunosorbent assay (ELISA) (R and D). PCT was determined in cell lysates by ECL Western blot. Results. PCT was found in relatively high concentrations (8.5 ± 4.8 ng/mL) only in patients with infected pancreatic necrosis, and in patients with sepsis of different origin (15 ± 5.4 ng/mL). Positive values (>1 ng/mL) preceded positive bacterial results from either blood or surgical samples. None of the serum samples of patients with SPN exhibited PCT concentrations higher than 1.2 ng/mL. In contrast, IL-6 and sICAM-1 were overproduced in both types (infected and sterile) of pancreatic necrosis, and their levels remained elevated for several days even after surgical elimination of the infected focus (widespread necrosectomy and continuous lavage). Sensitivity, specificity, and positive predictive values for discriminating IPN from SPN was 90, 100, and 100% for PCT (p <0.0001); 100, 20, and 55% for IL-6 (p 0.474 n.s.) and 90, 10, and 50% for sICAM-1 (p 1.000 n.s.). Immunoblotting revealed no PCT in patients' leukocytes, or in human endothelial cell lines. Conclusion. Elevated serum IL-6 and sICAM-1 levels are characteristic in systemic inflammatory response syndrome (SIRS) of either infectious or noninfectious origin. In contrast, the PCT level is an accurate, readily available parameter that allows the discrimination of IPN, and is a helpful marker facilitating a decision concerning surgical intervention.

Original languageEnglish
Pages (from-to)41-49
Number of pages9
JournalInternational Journal of Pancreatology
Volume28
Issue number1
Publication statusPublished - 2000

Fingerprint

Calcitonin
Pancreatitis
Interleukin-6
Necrosis
Sepsis
Serum
Enterochromaffin-like Cells
Cell Line
Systemic Inflammatory Response Syndrome
Clinical Laboratory Techniques
Therapeutic Irrigation
Berlin
Immunoblotting
Biological Assay
Germany
Leukocytes
Endothelial Cells
Western Blotting
Enzyme-Linked Immunosorbent Assay
Sensitivity and Specificity

Keywords

  • Endothelial cells
  • IL-6
  • Mononuclear cells
  • Pancreatitis
  • Procalcitonin
  • Sepsis
  • sICAM-1
  • Western blot

ASJC Scopus subject areas

  • Gastroenterology
  • Endocrinology
  • Oncology

Cite this

@article{74e1e3f29ef74974980a5cd44d0c648e,
title = "Diagnostic relevance of procalcitonin, IL-6, and sICAM-1 in the prediction of infected necrosis in acute pancreatitis",
abstract = "Background. Infected pancreatic necrosis (IPN) is an absolute indication for surgical intervention, therefore an early and accurate laboratory diagnosis is necessary to confirm the infection. The aim of the study was to analyze the clinical value of procalcitonin (PCT) for the prediction of infected necrosis, in comparison with interleukin-6 (IL-6) and sICAM-1. Patients and Methods. A total of 30 patients were investigated; 10 patients with sterile pancreatic necrosis (SPN), 10 with IPN, and 10 with sepsis of different origin. The concentrations of PCT in the patients' sera were measured by immunoluminometric assay (BRAHMS Diagnostica, Berlin, Germany, PCT Lumitest), the IL-6 concentrations by bioassay, applying the B-9 cell line, and the sICAM-1 levels by enzyme-linked immunosorbent assay (ELISA) (R and D). PCT was determined in cell lysates by ECL Western blot. Results. PCT was found in relatively high concentrations (8.5 ± 4.8 ng/mL) only in patients with infected pancreatic necrosis, and in patients with sepsis of different origin (15 ± 5.4 ng/mL). Positive values (>1 ng/mL) preceded positive bacterial results from either blood or surgical samples. None of the serum samples of patients with SPN exhibited PCT concentrations higher than 1.2 ng/mL. In contrast, IL-6 and sICAM-1 were overproduced in both types (infected and sterile) of pancreatic necrosis, and their levels remained elevated for several days even after surgical elimination of the infected focus (widespread necrosectomy and continuous lavage). Sensitivity, specificity, and positive predictive values for discriminating IPN from SPN was 90, 100, and 100{\%} for PCT (p <0.0001); 100, 20, and 55{\%} for IL-6 (p 0.474 n.s.) and 90, 10, and 50{\%} for sICAM-1 (p 1.000 n.s.). Immunoblotting revealed no PCT in patients' leukocytes, or in human endothelial cell lines. Conclusion. Elevated serum IL-6 and sICAM-1 levels are characteristic in systemic inflammatory response syndrome (SIRS) of either infectious or noninfectious origin. In contrast, the PCT level is an accurate, readily available parameter that allows the discrimination of IPN, and is a helpful marker facilitating a decision concerning surgical intervention.",
keywords = "Endothelial cells, IL-6, Mononuclear cells, Pancreatitis, Procalcitonin, Sepsis, sICAM-1, Western blot",
author = "Y. M{\'a}ndi and G. Farkas and T. Tak{\'a}cs and K. Boda and J. Lonovics",
year = "2000",
language = "English",
volume = "28",
pages = "41--49",
journal = "Journal of Gastrointestinal Cancer",
issn = "1941-6628",
publisher = "Humana Press",
number = "1",

}

TY - JOUR

T1 - Diagnostic relevance of procalcitonin, IL-6, and sICAM-1 in the prediction of infected necrosis in acute pancreatitis

AU - Mándi, Y.

AU - Farkas, G.

AU - Takács, T.

AU - Boda, K.

AU - Lonovics, J.

PY - 2000

Y1 - 2000

N2 - Background. Infected pancreatic necrosis (IPN) is an absolute indication for surgical intervention, therefore an early and accurate laboratory diagnosis is necessary to confirm the infection. The aim of the study was to analyze the clinical value of procalcitonin (PCT) for the prediction of infected necrosis, in comparison with interleukin-6 (IL-6) and sICAM-1. Patients and Methods. A total of 30 patients were investigated; 10 patients with sterile pancreatic necrosis (SPN), 10 with IPN, and 10 with sepsis of different origin. The concentrations of PCT in the patients' sera were measured by immunoluminometric assay (BRAHMS Diagnostica, Berlin, Germany, PCT Lumitest), the IL-6 concentrations by bioassay, applying the B-9 cell line, and the sICAM-1 levels by enzyme-linked immunosorbent assay (ELISA) (R and D). PCT was determined in cell lysates by ECL Western blot. Results. PCT was found in relatively high concentrations (8.5 ± 4.8 ng/mL) only in patients with infected pancreatic necrosis, and in patients with sepsis of different origin (15 ± 5.4 ng/mL). Positive values (>1 ng/mL) preceded positive bacterial results from either blood or surgical samples. None of the serum samples of patients with SPN exhibited PCT concentrations higher than 1.2 ng/mL. In contrast, IL-6 and sICAM-1 were overproduced in both types (infected and sterile) of pancreatic necrosis, and their levels remained elevated for several days even after surgical elimination of the infected focus (widespread necrosectomy and continuous lavage). Sensitivity, specificity, and positive predictive values for discriminating IPN from SPN was 90, 100, and 100% for PCT (p <0.0001); 100, 20, and 55% for IL-6 (p 0.474 n.s.) and 90, 10, and 50% for sICAM-1 (p 1.000 n.s.). Immunoblotting revealed no PCT in patients' leukocytes, or in human endothelial cell lines. Conclusion. Elevated serum IL-6 and sICAM-1 levels are characteristic in systemic inflammatory response syndrome (SIRS) of either infectious or noninfectious origin. In contrast, the PCT level is an accurate, readily available parameter that allows the discrimination of IPN, and is a helpful marker facilitating a decision concerning surgical intervention.

AB - Background. Infected pancreatic necrosis (IPN) is an absolute indication for surgical intervention, therefore an early and accurate laboratory diagnosis is necessary to confirm the infection. The aim of the study was to analyze the clinical value of procalcitonin (PCT) for the prediction of infected necrosis, in comparison with interleukin-6 (IL-6) and sICAM-1. Patients and Methods. A total of 30 patients were investigated; 10 patients with sterile pancreatic necrosis (SPN), 10 with IPN, and 10 with sepsis of different origin. The concentrations of PCT in the patients' sera were measured by immunoluminometric assay (BRAHMS Diagnostica, Berlin, Germany, PCT Lumitest), the IL-6 concentrations by bioassay, applying the B-9 cell line, and the sICAM-1 levels by enzyme-linked immunosorbent assay (ELISA) (R and D). PCT was determined in cell lysates by ECL Western blot. Results. PCT was found in relatively high concentrations (8.5 ± 4.8 ng/mL) only in patients with infected pancreatic necrosis, and in patients with sepsis of different origin (15 ± 5.4 ng/mL). Positive values (>1 ng/mL) preceded positive bacterial results from either blood or surgical samples. None of the serum samples of patients with SPN exhibited PCT concentrations higher than 1.2 ng/mL. In contrast, IL-6 and sICAM-1 were overproduced in both types (infected and sterile) of pancreatic necrosis, and their levels remained elevated for several days even after surgical elimination of the infected focus (widespread necrosectomy and continuous lavage). Sensitivity, specificity, and positive predictive values for discriminating IPN from SPN was 90, 100, and 100% for PCT (p <0.0001); 100, 20, and 55% for IL-6 (p 0.474 n.s.) and 90, 10, and 50% for sICAM-1 (p 1.000 n.s.). Immunoblotting revealed no PCT in patients' leukocytes, or in human endothelial cell lines. Conclusion. Elevated serum IL-6 and sICAM-1 levels are characteristic in systemic inflammatory response syndrome (SIRS) of either infectious or noninfectious origin. In contrast, the PCT level is an accurate, readily available parameter that allows the discrimination of IPN, and is a helpful marker facilitating a decision concerning surgical intervention.

KW - Endothelial cells

KW - IL-6

KW - Mononuclear cells

KW - Pancreatitis

KW - Procalcitonin

KW - Sepsis

KW - sICAM-1

KW - Western blot

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M3 - Article

VL - 28

SP - 41

EP - 49

JO - Journal of Gastrointestinal Cancer

JF - Journal of Gastrointestinal Cancer

SN - 1941-6628

IS - 1

ER -