DIAGNOSIS PURULENT SEPTIC COMPLICATIONS OF ACUTE NECROTIZING PANCREATITIS

Abstract. Purulent complications seriously worsen the prognosis in patients with acute necrotizing pancreatitis. Early diagnosis is an important issue in establishing of their effective conservative and interventional treatment. Recently procalcitonin was proposed as a diagnostic criterion of bacterial contamination of pancreatic necrotic tissue. Purpose – to estimate efficacy of procalcitonin for early diagnosis of purulent-septic complications of acute necrotizing pancreatitis and to explore its utility for the prognosis of disease forecast. Material and methods. Prospective cohort study of 151 patients with severe acute necrotizing pancreatitis has been performed. Clinical, bacteriological and instrumental investigations were carried out. Serum levels of procalcitonin were determined. Results and discussion. Infection of necrotic collection was diagnosed at 89 (55,6%) patients: local purulent complications at 27, sepsis – at 33, septic shock – at 29 observations. In 62 patients with sterile acute necrotizing pancreatitis the procalcitonin concentration was higher than in healthy individuals and reached (1,34 ± 0.19) ng/ml (p=0,045). The development of infected acute necrotizing pancreatitis was accompanied by an increase of procalcitonin concentration in patients with sepsis to (5,03 ± 1.38) ng/ml (p=0,001) and septic shock — up to (7,21 ± 1,91) ng/ml (p=0,001), while in persons with localized form it was (2,03 ± 0,48) ng/ml (p=0,072). Procalcitonin level above 4,0 ng/ml was prognostically unfavourable for the survival of patients. Conclusion. Serum procalcitonin level is an effective tool for the diagnosis of generalized infectious complications of acute necrotizing pancreatitis P. Its level over 4.0 ng/ml indicates an unfavourable prognosis for patients’ survival.