Predictive Value Of PCT Combined With CRP And D Dimer For Moderately Severe And Severe Acute Pancreatitis

Objective:To investigate the predictive value of a parametric model(PM)constructed by the maximum serum concentrations of procalcitonin(PCT),C-reactive protein(CRP),D dimer(DD)within 48 hours after admission for moderately severe and severe acute pancreatitis.Methods:A retrospective study was conducted on 238 patients with acute pancreatitis who were hospitalized at the First Affiliated Hospital of Fujian Medical University for the first time on January 1,2015 and June 30,2020.According to the diagnostic criteria of Chinese guidelines for diagnosis and treatment of acute pancreatitis(Shenyang,2019),68 patients were divided into mild(MAP)group,and 170 patients were divided into moderately severe and severe(MSAP+SAP)group.The maximum serum concentrations of PCT,CRP,DD within 48 hours after admission(PCT48h,CRP48 h,DD48h)and general clinical data were collected.The differences of PCT48 h,CRP48h,DD48 h between 2 groups were compared.And the correlation between PCT48 h,CRP48h,DD48 h and severity scoring systems of acute pancreatitis was analyzed,as well as the predictive value of three indicators alone and joint detection for moderately severe and severe acute pancreatitis.The predictive value of the parametric model constructed by PCT48 h,CRP48h and DD48 h for MSAP+SAP were compared with MCTSI,Ranson score,APACHE II score,BISAP and modified Marshall score.The SPSS22.0 software was used for statistical analysis of the date in this study.Results:1.The serum concentrations of PCT48 h,CRP48h and DD48 h in MSAP+SAP group were all higher than those in MAP group,with statistically significant differences(P<0.001).2.ROC curves of PCT48 h,CRP48h and DD48 h for the prediction of MSAP+SAP were drawn as follows: the area under the PCT48 h curve was 0.795(95%CI:0.735-0.855),and the sensitivity,specificity,Youden index and critical value for predicting MSAP+SAP were 78.20%,69.10%,47.30% and 0.255 ng/m L,respectively.The area under the CRP48 h curve was 0.768(95%CI: 0.698-0.837),and the sensitivity,specificity,Youden index and critical value for predicting MSAP+SAP were 72.90%,80.90%,53.80% and 84.340 mg/L,respectively.The area under the DD48 h curve was0.789(95%CI: 0.726-0.852),and the sensitivity,specificity,Youden index and critical value for predicting MSAP+SAP were 74.70%,75.00%,49.70% and 1.805 mg/L,respectively.The area under the curve of the parametric model was 0.853(95%CI:0.804-0.903),and the sensitivity,specificity,Youden index and critical value for predicting MSAP+SAP were 84.71%,70.59%,55.30% and 0.2833,respectively.3.The sensitivity,AUC value and Youden index(84.71%,0.853,55.30%,respectively)of the parametric model to predict MSAP+SAP were higher than those of MCTSI(84.00%,0.798,43.50%,respectively),Ranson score(73.53%,0.777,41.18%,respectively),BISAP(56.47%,0.712,30.00%,respectively),APACHE II score(27.65%,0.535,4.10%,respectively)and modified Marshall score(17.06%,0.654,17.10%,respectively).The specificity(70.59%)was lower than BISAP(73.53%),APACHE II score(76.47%)and modified Marshall score(100.00%).Conclusions:1.Within 48 hours after admission,PCT48 h,CRP48h and DD48 h can be used as predictive indicators of MSAP+SAP.2.The parametric model constructed by PCT48 h,CRP48h and DD48 h can predict the severity of MSAP+SAP,and the predictive value of it is higher than that of a single indicator.3.The sensitivity,Youden index and predictive value of the parametric model is higher than MCTSI,Ranson score,BISAP,APACHE II score and modified Marshall score.4.The critical value of the parametric model for predicting MSAP+SAP is preliminarily determined,which could be used as a reference value.