Prediction of Severity of Acute Pancreatitis by Biochemical Markers: A Tertiary Care Hospital Study

Author(s): Shanjidah Hoque, Rifat Hassan, Naheen Rezuan Shehran Asif

Background: Acute pancreatitis (AP) is an acute inflammatory condition of the pancreas which may extend to local and distant extra pancreatic tissues. It is a life-threatening disease that has many causes, few effective treatments and numerous serious complications. Early diagnosis of acute pancreatitis and effective treatment can significantly reduce the mortality and morbidity of such cases.

Aim of the study: The aim of this study was to predict the severity of acute pancreatitis by biochemical markers.

Methods: This was a prospective observational study which was conducted on 35 admitted patients with diagnosis of acute pancreatitis at BIRDEM General Hospital, Dhaka, Bangladesh from October 2016 to April 2017. Complete blood count, serum amylase, serum lipase, C-reactive protein and serum procalcitonin values were observed. Data were collected from history, clinical findings and investigations. All data were collected, processed and analyzed by using MS Office and SPSS version 20.0 as per need.

Results: Among 35 patients, age range was 28-76 years. Number of male patients was 19 and number of female patients was 16. Among total patients, 21(60%) had mild attack and 14 (40%) patients had severe attack of acute pancreatitis. C- reactive protein (CRP) and procalcitonin (PCT) can differentiate between mild and severe acute pancreatitis. Among the parameters of the patients, P value of CRP was 0.047 and P value of procalcitonin (PCT) was 0.032, less than 0.05 which were statistically significant. These studies have shown that, serum procalcitonin (PCT) is a good marker for predicting severity and development of organ failure in acute pancreatitis and it is superior to serum C- reactive protein. Total WBC count was high in both mild and severe acute group patients with pancreatitis patients. Haemoglobin values and other baseline parameters showed no significant differences between two groups of patients. Serum amylase and serum lipase values were high in both groups. The magnitude of the elevation of amylase and lipase does not predict disease severity.

Conclusion: C- reactive protein (CRP) and procalcitonin (PCT) can differentiate between mild and severe acute pancreatitis. This prospective study was undertaken to evaluate in 35 patients with acute pancreatitis whether the new marker of systemic inflammation, PCT, had predict severe acute pancreatitis. The result was compared with CRP. PCT had a sensitivity of 91% and a specificity of 81%, which was superior to other tests.