C-reactive Protein And Procalcitonin In Early Assessment Of The Severe Acute Pancreatitis:a Meta-analysis

Objective:Acute pancreatitis(AP) is an disease with a highly variable severity. The severity classification of acute pancreatitis is very important in the diagnosis and treatment. We have a lot of score standards to evaluate the severity of AP, including:APACHE II score,Balthazar CT rating, Ranson score and MCTSI rating etc. These standards have been widely using in clinical and have played an important role in this fiield. This paper mainly compares C-reactive protein(CRP) with procalcitonin(PCT) in predicting the severe acute pancreatitis in the early phase. The systematic analysis will discuss the two indicators, CRP and PCT, by the method of evidence-based medicine, providing some help for early assessment of severe acute pancreatitis.Methods:Major databases including Pub Med, EMBASE, EBSCO, MEDLINE, Cochrane Library,Science Citation Index database, China academic journal full text database, Chinese biomedical literature database, Chinese science and technology periodical database were searched to identify all relevant studies before March 2016. We use established standards to the select the target literatures. We analyzed the heterogeneity of dates in the first place,and then merged the sensitivity and specificity of both indicators using Meta-Disc 1.4statistical software.We finally discussed the meaning of CRP and PCT in assessing the severe acute pancreatitis in early stage.Results:We primary retrieved 479 references, including 382 articles in Chinese and 97 articles in English.We finally selected seven references, including five articles in English and 2articles in Chinese.We used the meta-disc1.4 statistical software to calculate the the diagnostic odds ratio(DOR) of the basic data which suggests that the heterogeneity of the two indicators is high. The further analysis results suggest that the heterogeneity of both indexs comes from nonthreshold-effect. Subgroup-analysis of both index,CRP and PCT,were carried out to predict the severe acute pancreatitis,which including sensitivity 、severity、PLR、 NLR、AUC,during the early stage(within 24 hours).We have reached that the results were 79%(95%CI: 70%-86%) and 52%(95%CI: 45%-59%), 97%(95%CI:95%-99%) and 95%(95%CI: 92%-97%), 21.43(4.47-102.73) and 9.19(4.80-17.61), 0.20(0.11-0.37) and 0.23(0.05-0.84), 0.9752 and 0.9224,respectively.Conclusions:The sensitivity and specificity of CRP and PCT in predicting the severe acute pancreatitis during the early stage were 79% vs 52% and 97% vs 95%, respectively. Both indexes have certain value in the early diagnosis of severe acute pancreatitis.CRP is of higher efficiency than PCT.