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my personal edition > surgery > news
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DGReview
Interleukin 6, Procalcitonin Levels Help Predict Necrosis Infection In Acute Pancreatitis
A DGReview of :"Inflammatory cytokines, C reactive protein, and procalcitonin as early predictors of necrosis infection in acute necrotizing pancreatitis"
Surgery
04/03/2003
By James Adams
Serum levels of interleukin 6 (IL-6) and procalcitonin are elevated in acute pancreatitis patients who will eventually develop necrosis infection.
Necrosis infection is a major risk in acute pancreatitis. Broad spectrum antibiotics are systematically used in these patients, but with the potential of serious side effects, explain investigators from the Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, France.
Threshold levels of procalcitonin and IL-6 may help distinguish between patients who will or will not develop infection and thus identify those who are not likely to benefit from antibiotics.
The investigators measured serum levels of IL-6, tumour necrosis factor-alpha, C-reactive protein, and procalcitonin within three days of admission of 48 patients with acute pancreatitis.
Patients were divided into infected and non-infected groups, and receiver operating curves methodology was used to determine a threshold for markers that could predict the development of infected necrosis.
Results showed that procalcitonin and IL-6 were elevated in the serum of patients who eventually developed infected necrosis. Tumour necrosis factor-alpha and C-reactive protein did not significantly differ between the two groups.
A combination of IL-6 below 400 picograms/litre and procalcitonin below two nanograms/litre best identified patients who were not at risk of necrosis infection. The negative predictive value of this combined threshold was 91 per cent. Sensitivity and specificity were 75 and 84 per cent, respectively.
The investigators conclude that procalcitonin and IL-6 are elevated in patients who will develop necrosis infection. Antibiotic prophylaxis may not be beneficial for patients who are below a combined threshold for these two markers.
Surgery 2003;133:3:257-262.
"Inflammatory cytokines, C reactive protein, and procalcitonin as early predictors of necrosis infection in acute necrotizing pancreatitis"
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