Value of serum lipase, C-reactive protein and procalcitonin in prediction of infected pancreatic necrosis after severe pancreatitis

doi:10.3877/cma.j.issn.1674-0785.2021.08.013

Abstract

Abstract:

Objective

To assess the value of serum lipase, C-reactive protein (CRP) and procalcitonin (PCT) in the prediction of infected pancreatic necrosis (IPN) in patients with severe acute pancreatitis (SAP), to provide a research basis for its clinical diagnosis and treatment.

Methods

A total of 132 SAP patients treated at the Haikou People's Hospital from December 2018 to December 2020 were selected as the study subjects. According to whether IPN occurred, the patients were divided into either an IPN group (48 cases) or a non-IPN group (84 cases). The general data and the levels of white blood cells (WBCs), hemoglobin (HB), albumin (ALB), serum amylase, serum lipase, PCT, and CRP were compared between the two groups. Receiver operating characteristic (ROC) curve analysis was performed to assess the value of serum lipase, PCT, and CRP levels in the prediction of IPN after SAP.

Results

The differences of WBCs, HB, ALB and amylase between the two groups were not statistically significant (P＞0.05), but the levels of serum lipase, PCT, and CRP in the IPN group were [(790.60±294.08) U/lL, (11.90±5.67) ng/ml, and (292.12±67.97) mg/L, respectively] were significantly higher than those of the non-IPN group [(555.09±213.44) U/L, (5.69±3.34) ng/ml, and (204.89±44.15) mg/L, respectively; P＜0.05]. The area under ROC curve (AUC^ROC) values of serum lipase, PCT, and CRP levels in the diagnosis of IPN after SAP were 0.727, 0.808, and 0.845, respectively (P＜0.05), among which the AUC of CRP was the highest, with a sensitivity of 60.42% and of 91.67% at the cutoff value of 278.841 mg/L.

Conclusion

Serum lipase, PCT, and CRP levels in early stage of SAP have appreciated value for auxiliary prediction of IPN, but they are limited by a low sensitivity, which is not enough to meet clinical needs. Multiple indicators should still be used to improve the prediction efficiency.

Key words: Lipase, C-reactive protein, Procalcitonin, Acute severe pancreatitis, Infected pancreatic necrosis

Yingbin Chen, Ying Li, Yu Hou, Jun Chen, Wufeng Huang, Hui Wen, Xing Su. Value of serum lipase, C-reactive protein and procalcitonin in prediction of infected pancreatic necrosis after severe pancreatitis[J]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(08): 626-630.

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Figures/Tables 4

组别	例数	年龄（岁， $x ¯$ ±s）	性别［例（%）］		病因［例（%）］		糖尿病［例（%）］	高血压［例（%）］
组别	例数	年龄（岁， $x ¯$ ±s）	男	女	胆源性	非胆源性	糖尿病［例（%）］	高血压［例（%）］
IPN组	48	54.46±8.63	30（62.5）	18（37.5）	29（60.42）	19（39.58）	20（41.67）	22（45.83）
非IPN组	84	53.18±8.04	47（55.95）	37（44.05）	48（57.14）	36（42.86）	29（34.52）	32（38.10）
统计值		t=0.857	χ²=0.539		χ²=0.135		χ²=0.668	χ²=0.757
P值		0.102	0.463		0.714		0.414	0.384

组别	例数	年龄（岁， $x ¯$ ±s）	性别［例（%）］		病因［例（%）］		糖尿病［例（%）］	高血压［例（%）］
组别	例数	年龄（岁， $x ¯$ ±s）	男	女	胆源性	非胆源性	糖尿病［例（%）］	高血压［例（%）］
IPN组	48	54.46±8.63	30（62.5）	18（37.5）	29（60.42）	19（39.58）	20（41.67）	22（45.83）
非IPN组	84	53.18±8.04	47（55.95）	37（44.05）	48（57.14）	36（42.86）	29（34.52）	32（38.10）
统计值		t=0.857	χ²=0.539		χ²=0.135		χ²=0.668	χ²=0.757
P值		0.102	0.463		0.714		0.414	0.384

项目	IPN组（48例）	非IPN组（84例）	t值	P值
WBC（×10Q⁹/L）	13.15±3.87	12.89±3.95	0.366	0.635
HB（g/L）	115.53±13.05	117.71±15.23	-0.832	0.106
ALB（g/L）	36.46±4.41	36.85±4.56	-0.478	0.529
淀粉酶（U/L）	706.68±221.16	682.24±225.69	0.603	0.398
脂肪酶（U/L）	790.60±294.08	555.09±213.44	4.864	＜0.001
PCT（ng/mL）	11.90±5.67	5.69±3.34	6.931	＜0.001
CRP（mg/L）	292.12±67.97	204.89±44.15	7.982	＜0.001

检测指标	AUC^ROC	标准误	P值	AUC^ROC的95%置信区间	cutoff值	敏感度（%）	特异度（%）
脂肪酶	0.727	0.047	＜0.001	0.635~0.820	913.641 U/L	37.50	98.81
PCT	0.808	0.042	＜0.001	0.726~0.890	11.248 ng/ml	58.33	97.62
CRP	0.845	0.036	＜0.001	0.774~0.916	278.841 mg/L	60.42	91.67

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