Persistently High Procalcitonin and C-Reactive Protein Are Good Predictors of Infection
in Acute Necrotizing Pancreatitis: A Systematic Review and Meta-Analysis
(TKP2021-EGA-23) Funder: Ministry for Innovation and Technology
(RRF-2.3.1-21-2022-00011)
(K131996)
(K147265)
(FK131864)
(UNKP-22-5)
(ÚNKP-22-3)
Subjects:
Meta-analysis
Infected necrotizing pancreatitis (INP) is associated with an increased risk of organ
failure and mortality. Its early recognition and timely initiation of antibiotic therapy
can save patients’ lives. We systematically searched three databases on 27 October
2022. In the eligible studies, the presence of infection in necrotizing pancreatitis
was confirmed via a reference test, which involved either the identification of gas
within the necrotic collection through computed tomography imaging or the examination
of collected samples, which yielded positive results in Gram staining or culture.
Laboratory biomarkers compared between sterile necrotizing pancreatitis and INP were
used as the index test, and our outcome measures included sensitivity, specificity,
the receiver operating characteristic (ROC) curve and area under the ROC curve (AUC).
Within the first 72 hours (h) after admission, the AUC of C-reactive protein (CRP)
was 0.69 (confidence interval (CI): 0.62–0.76), for procalcitonin (PCT), it was 0.69
(CI: 0.60–0.78), and for white blood cell count, it was 0.61 (CI: 0.47–0.75). After
the first 72 h, the pooled AUC of CRP showed an elevated level of 0.88 (CI: 0.75–1.00),
and for PCT, it was 0.86 (CI: 0.60–1.11). The predictive value of CRP and PCT for
infection is poor within 72 h after hospital admission but seems good after the first
72 h. Based on these results, infection is likely in case of persistently high CRP
and PCT, and antibiotic initiation may be recommended.