[Prognostic value of C reactive protein in acute pancreatitis]

Controversy still exists regarding the clinical features of acute pancreatitis: it is not known whether this is a disease which progresses from mild to severe forms or which arises immediately as severe acute pancreatitis. An early diagnosis, however, is regarded as mandatory for successful treatment. Over the years many Authors have proposed different scoring systems for the early assessment of the clinical evolution of acute pancreatitis. The most widely used scoring systems (Ranson, Osborne, Apache II) are often cumbersome and difficult to use in clinical practice because of their multifactorial nature. Thus, a number of unifactorial prognostic indices have been employed in routine hospital practice, such as C-reactive protein, serum amylase and serum lipase. These serum enzymes are easy to obtain in normal clinical practice and many authors consider them as reliable as multifactorial scoring systems. One hundred and five patients affected by acute pancreatitis have been hospitalised in the Surgical Department of San Giacomo Hospital (Rome) over an nine-year period. All patients underwent C-reactive protein, amylase, and lipase serum assays on days 1, 3 and 5 after admission. The results show that C-reactive protein assay is highly sensitive in detecting necrotic forms of acute pancreatitis. The authors conclude that C-reactive protein, together with both serum amylase and serum lipase, often provides a precise picture of the clinical situation in patients with acute pancreatitis. On this basis the best therapeutic option can be chosen.