Procalcitonin, C-Reactive Protein, and Neutrophil Ratio Contrib-ute to the Diagnosis and Prognosis of Severe Acute Pancreatitis

  • Yi LIANG Department of Emergency, Affiliated Hospital of Jining Medical University, Jining, P.R. China
  • Xianwei ZHAO Department of Digestive System, Shangdong Institute of Parasitical Disease, Shandong Academy of Medical Science, Jining, P.R. China
  • Fanliang MENG Department of Emergency, Affiliated Hospital of Jining Medical University, Jining, P.R. China
Keywords: Acute severe pancreatitis; Procalcitonin; C-reactive protein; Neutrophil ratio; Diagnosis



Background: We aimed to explore the significance of procalcitonin (PCT), C-reactive protein (CRP) and neutrophil ratio (N%) in the early diagnosis, treatment, and prognosis of severe acute pancreatitis (SAP).

Methods: A total of 104 patients with SAP (SAP group) and 101 patients with mild acute pancreatitis (MAP) (MAP group) admitted to Affiliated Hospital of Jining Medical University, Jining, China were enrolled. The PCT and CRP in serum were detected by a full-automatic biochemical analyzer, and N% in peripheral blood was measured by a hemocyte analyzer.

Results: The peripheral blood PCT, CRP, and N% in the SAP group were significantly higher than those in the MAP group (P<0.001). Multivariate Logistic regression analysis showed that acute physiology and chronic health evaluation II (APACHE II) score, Ranson score, PCT, CRP, and N% were independent risk factors for SAP. The receiver operating characteristic (ROC) curve showed that the area under curve (AUC) of PCT, CRP, and N% in diagnosing SAP were 0.906, 0.840, and 0.834 respectively, while that of combined detection was 0.972. The AUC of PCT, CRP, and N% in diagnosing SAP death were 0.907, 0.900, and 0.894, respectively.

Conclusions: Peripheral blood PCT, CRP, and N% contribute to the diagnosis and prognosis of SAP.



1. Deng LH, Hu C, Cai WH, et al (2017). Plasma cytokines can help to identify the development of severe acute pancreatitis on admission. Medicine (Baltimore), 96(28): e7312.
2. Portelli M, Jones CD (2017). Severe acute pancreatitis: pathogenesis, diagnosis and surgical management. Hepatobiliary Pancreat Dis Int, 16: 155-159.
3. Otsuki M, Takeda K, Matsuno S, et al (2013). Criteria for the diagnosis and se-verity stratification of acute pancreatitis. World J Gastroenterol, 19: 5798-5805.
4. Wang GJ, Gao CF, Wei D, Wang C, Ding SQ (2009). Acute pancreatitis: etiology and common pathogenesis. World J Gas-troenterol, 15: 1427-1430.
5. Swaroop VS, Chari ST, Clain JE (2004). Se-vere acute pancreatitis. JAMA, 291: 2865-2868.
6. Yang L, Liu J, Xing Y, Du L, Chen J, Liu X, Hao J (2016). Comparison of BISAP, Ranson, MCTSI, and APACHE II in predicting severity and prognoses of hy-perlipidemic acute pancreatitis in Chinese patients. Gastroenterol Res Pract, 2016: 1834256.
7. Ismail OZ, Bhayana V (2017). Lipase or am-ylase for the diagnosis of acute pancreati-tis? Clin Biochem, 50: 1275-1280.
8. Chen YJ, Zhuang YD, Cai Z (2019). Effects of enteral nutrition on pro-inflammatory factors and intestinal barrier function in patients with acute severe pancreatitis. Eur J Inflamm, 17: 2058739219827212.
9. Bereanu AS, Sava M (2015). Correlation be-tween Intra-Abdominal Pressure and C- Reactive Protein in Acute Pancreatitis. Ac-ta Medica Transilvanica, 20: 109-113.
10. Liu T, Huang W, Szatmary P, et al (2017). Accuracy of circulating histones in pre-dicting persistent organ failure and mor-tality in patients with acute pancreatitis. Br J Surg, 104: 1215-1225.
11. Simsek O, Kocael A, Kocael P, et al (2018). Inflammatory mediators in the diagnosis and treatment of acute pancreatitis: pen-traxin-3, procalcitonin and myeloperoxi-dase. Arch Med Sci, 14: 288-296.
12. Yang Z, Meng X, Xu P (2015). Central role of neutrophil in the pathogenesis of se-vere acute pancreatitis. J Cell Mol Med, 19: 2513-2520.
13. Staubli SM, Oertli D, Nebiker CA (2015). Laboratory markers predicting severity of acute pancreatitis. Crit Rev Clin Lab Sci, 52: 273-283.
14. Zheng W, Zhang L, Long G, Chen B, Shu X, Jiang M (2018). Amalgamation of sys-temic inflammatory response syndrome score with C-reactive protein level in evaluating acute pancreatitis severity in children. Scand J Gastroenterol, 53: 755-759.
15. Merza M, Hartman H, Rahman M, et al (2015). Neutrophil extracellular traps in-duce trypsin activation, inflammation, and tissue damage in mice with severe acute pancreatitis. Gastroenterology, 149: 1920-1931. e8.
16. Ignatavicius P, Gulla A, Cernauskis K, Barauskas G, Dambrauskas Z (2017). How severe is moderately severe acute pancreatitis? Clinical validation of revised 2012 Atlanta Classification. World J Gas-troenterol, 23: 7785-7790.
17. Tenner S, Baillie J, DeWitt J, Vege SS (2013). American College of Gastroenterology guideline: management of acute pancreati-tis. Am J Gastroenterol, 108: 1400-1415.
18. Dashti R, Al Jarallah M, Rajan R, Al Mulla K, Khalil M, Sayed W (2018). Ruptured mi-tral valve abscess with mitral incompe-tence in culture negative infective endo-carditis: case report. Eur Heart J Case Rep, 2: yty003.
19. Jeong DK, Lee HW, Kwon YM (2015). Clinical value of procalcitonin in patients with spinal infection. J Korean Neurosurg Soc, 58: 271-275.
20. Moukarbel GV, Yu ZF, Dickstein K, et al (2014). The impact of kidney function on outcomes following high risk myocardial infarction: findings from 27 610 patients. Eur J Heart Fail, 16: 289-299.
21. Ji L, Lv JC, Song ZF, Jiang MT, Li L, Sun B (2016). Risk factors of infected pancreatic necrosis secondary to severe acute pan-creatitis. Hepatobiliary Pancreat Dis Int, 15: 428-433.
22. Yang R, Tenhunen J, Tonnessen TI (2017). HMGB1 and histones play a significant role in inducing systemic inflammation and multiple organ dysfunctions in severe acute pancreatitis. Int J Inflam, 2017: 1817564.
23. Maheshwari R, Subramanian RM (2016). Se-vere acute pancreatitis and necrotizing pancreatitis. Crit Care Clin, 32: 279-290.
24. Cho J H, Kim T N, Chung H H, Kim KH (2015). Comparison of scoring systems in predicting the severity of acute pancre-atitis. World J Gastroenterol, 21: 2387-94.
25. Harshit Kumar A, Singh Griwan M (2017). A comparison of APACHE II, BISAP, Ranson’s score and modified CTSI in predicting the severity of acute pancreati-tis based on the 2012 revised Atlanta Classification. Gastroenterol Rep (Oxf), 6: 127-131.
26. Dias BH, Rozario AP, Olakkengil SA (2015), VA. Procalcitonin strip test as an inde-pendent predictor in acute pancreatitis. Indian J Surg, 77: 1012-1017.
27. Frossard J L, Hadengue A, Pastor C M (2001). New serum markers for the de-tection of severe acute pancreatitis in hu-mans. Am J Respir Crit Care Med, 164: 162-170.
28. Gao N, Yan C, Zhang G (2018). Changes of serum procalcitonin (PCT), C-reactive protein (CRP), interleukin-17 (IL-17), In-terleukin-6 (IL-6), high mobility group protein-B1 (HMGB1) and D-dimer in patients with Severe acute pancreatitis treated with continuous renal replacement therapy (CRRT) and its clinical signifi-cance. Med Sci Monit, 24: 5881.
29. Jeon T J, Park J Y (2017). Clinical signifi-cance of the neutrophil-lymphocyte ratio as an early predictive marker for adverse outcomes in patients with acute pancreati-tis. World J Gastroenterol, 23: 3883-89.
30. Zhang XP, Zhang J, Song QL, Chen HQ (2007). Mechanism of acute pancreatitis complicated with injury of intestinal mu-cosa barrier. J Zhejiang Univ Sci B, 8: 888-895.
31. Fisic E, Poropat G, Bilic-Zulle L, Licul V, Milic S, Stimac D (2013). The role of IL-6, 8, and 10, sTNFr, CRP, and pan-creatic elastase in the prediction of sys-temic complications in patients with acute pancreatitis. Gastroenterol Res Pract, 2013: 282645.
32. Khanna AK, Meher S, Prakash S, et al (2013). Comparison of Ranson, Glas-gow, MOSS, SIRS, BISAP, APACHE-II, CTSI Scores, IL-6, CRP, and procalciton-in in predicting severity, organ failure, pancreatic necrosis, and mortality in acute pancreatitis. HPB Surg, 2013: 367581.
33. Rau BM, Kemppainen EA, Gumbs AA, Büchler MW, Wegscheider K, Bassi C, Puolakkainen PA (2007), Beger HG. Early assessment of pancreatic infections and overall prognosis in severe acute pancrea-titis by procalcitonin (PCT): a prospective international multicenter study. Ann Surg, 245: 745-754.
34. Cardoso FS, Ricardo LB, Oliveira AM, et al (2013). C-reactive protein prognostic ac-curacy in acute pancreatitis: timing of measurement and cutoff points. Eur J Gastroenterol Hepatol, 25: 784-789.
35. Azab B, Jaglall N, Atallah JP, et al (2011). Neutrophil-lymphocyte ratio as a predic-tor of adverse outcomes of acute pancre-atitis. Pancreatology, 11: 445-452.
How to Cite
LIANG Y, ZHAO X, MENG F. Procalcitonin, C-Reactive Protein, and Neutrophil Ratio Contrib-ute to the Diagnosis and Prognosis of Severe Acute Pancreatitis. Iran J Public Health. 48(12):2177-2186.
Original Article(s)