Utility of Procalcitonin and Interleukin-6 Blood Levels for Prediction of Outcome in Patients with Severe Acute Pancreatitis

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  • Kato Noboru
    Department of Emergency and Critical Care Medicine, Osaka City University Graduate School of Medicine
  • Yukioka Hidekazu
    Department of Anesthesia, Emergency and Intensive Care, Yukioka Hospital

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  • 重症急性膵炎における予後予測の早期指標としてのプロカルシトニン，ＩＬ‐６値の有用性

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Patients: This study was performed on 13 patients with severe acute pancreatitis diagnosed according to Japanese severity score between November 2001 and May 2003 who underwent testing to determine procalcitonin (PCT) and interleukin-6 (IL-6) blood levels. Japanese severity score was 9.5 ± 4.7 (range 4-19) and APACHE II score 13.2 ± 6.7 (range 7-29). Four patients had multiple organ failure (MOF) (SOFA score 14.3 ± 3.9, range 10-17) within 7 days after admission, and finally died due to MOF. Measurements: PCT was measured by immunoluminometric assay and IL-6 by ELISA. Measurements of PCT and IL-6 were mainly performed within 48 hours (within 4 days after onset of severe acute pancreatitis), on the 3-4th day, and the 7th day after admission (total 41 measurements). Data analyses were performed using the Mann-Whitney U test and Spearman's rank correlation test. Findings of p<0.05 were considered significant. Results: PCT (ng/ml) and IL-6 (× 103 pg/ml) blood levels within 48 hours after admission were 2.83 ± 3.92 (range 0.08-12.61) and 5.45 ± 15.08 (range 0.05-54.87), respectively. IL-6 level was slightly correlated with Japanese severity score (rs=0.570, p=0.0495) and PCT level was nearly correlated with it (rs=0.554, p=0.0565). Both PCT and IL-6 levels were strongly correlated with APACHE II score (rs=0.735, p=0.0113 and rs=0.663, p=0.0226, respectively). PCT (ng/ml) and IL-6 (× 103 pg/ml) levels within 48 hours after admission in the 4 patients who died were significantly higher than those in the 9 patients who survived (7.63 ± 4.01 and 17.20 ± 25.36 vs. 0.70 ± 0.61 and 0.23 ± 0.12, p=0.0055 and p=0.0055, respectively). The results were similar on the 3-4th and the 7th days. Both sensitivity and specificity for the prediction of death were 100% when the cut off levels were 2.0 ng/ml for PCT and 1.0 × 103 pg/ml for IL-6 within 48 hours after admission. A good correlation was found between PCT and IL-6 levels at all times of measurement (rs=0.741, p=0.0079). Conclusions: Both PCT and IL-6 levels measured within 4 days after onset of severe acute pancreatitis were useful for predicting outcome.

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