C-reactive protein in early prediction of pancreatic necrosis

to determine relation between the C-reactive protein and pancreatic necrosis, and to estimate the prognostic value of C-reactive protein in early diagnosis of pancreatic necrosis.

During 2001, 78 patients with acute pancreatitis were included in the study. The clinical data, diagnostic procedures, and laboratory values were analyzed. According to severity of the disease patients were divided into two groups. Group I consisted of 17 patients with necrotic pancreatitis, group II--of 61 patients with pancreatic edema. Contrast-enhanced computed tomography scan was used to diagnose pancreatic necrosis with subsequent fine-needle aspiration for microbiological evaluation. C-reactive protein concentration in serum was measured on day 1, 2, 3, 5, 7 and 9 after admission. The sensitivity, specificity, positive and negative predictive values for different C-reactive protein concentration cut-off (100-150 mg/l) were calculated. Average C-reactive protein values were compared between groups by t test for unpaired data. The difference was assumed statistically significant when p<0.05.

There was no significant difference in demographic data between the groups. Necrosis of the pancreas was demonstrated on computed tomography scan in 17 cases. The highest C-reactive protein values were detected on day 3 in group I patients. The difference of average C-reactive protein concentration was significant between groups on all days except day 7. The highest sensitivity and negative predictive value (94.1% and 95.7% respectively) was obtained for C-reactive protein cut-off at 110 mg/l.

The results of our study show the C-reactive protein values increase significantly in early stages of necrotic pancreatitis. C-reactive protein is an important prognostic marker of pancreatic necrosis with the highest sensitivity and negative prognostic value given the cut-off is 110 mg/l. The patients with C-reactive protein below 110 mg/l are low risk to develop pancreatic necrosis.