The Application Of Serum Procalcitonin In Evaluating The Prognosis Of Acute Pancreatitis

Objective:To study the dynamic changes of procalcitonin level in the prognosis?occurrence,development and outcome?of patients with acute pancreatitis and explore its significance,so as to improve the clinical evaluation effect of stratification and prognosis of patients with acute pancreatitis.Research materials and Methods:To collect and analyze the general information of126 AP patients in our hospital from June 2017 to June 2019,To collect PCT values,blood routine and biochemical indicators on the first,second and third day of admission,discharge or death day.To collect and calculate the indicators needed for scoring in the conventional evaluation scheme?APACHE II?BISAP?Ranson?Marshall?MEWS?on the same day.To compare the evaluation effect of PCT on SAP with other inspection indexes and evaluation schemes,To obtain the best time point and the best threshold for PCT to evaluate SAP.To compare the evaluation effect of PCT with other inspection indexes and evaluation schemes on organ failure in patients and the evaluation effect on admission to ICU.To compare the evaluation effect of each scheme on different prognosis,and compare the evaluation effects of each scheme on the outcomes in different time periods.Results:?1?It was found there was no association between the general information of patients with AP severity stratification and PCT level?P>0.05?.?2?The highest correlation was found between PCT and the severity of AP in all inspection indexes on the day of admission?r=0.803?.WBC,NLR,MCV,CRP,urea,LDH,RDW,and creatinine had positively correlated with the severity of AP,and blood Ca²⁺had negatively correlated with AP severity?P<0.05?,while HCT,PLT,ALT,and AST had no correlated with AP severity.It showed that the levels of PCT and CRP were statistically different in different severity groups?P<0.05?,PCT and CRP levels in group SAP>group MSAP>group MAP,WBC levels in group SAP>group Non-SAP,and Ca²⁺levels in group SAP<group Non-SAP.The conventional evaluation scheme levels in group SAP>group Non-SA.It showed that PCT and CRP had correlations with the conventional evaluation scheme?P<0.05?.ROC curve analysis showed that PCT could recognize SAP and its AUC value was 0.936.When PCT took 3.16ng/ml as the best threshold,its sensitivity and specificity were 92.60%and 94.90%,and its+LR was 18.16 and-LR was 0.08.?3?It showed that PCT at different time in the early days of admission could identify SAP,and the PCT value of the SAP group was always>in the non-sap group.ROC curve analysis showed that the AUC value of the PCT value assessed by SAP on the first day of admission was the largest.?4?Among all patients with organ failure,respiratory failure was the most common in both non-persistent and persistent groups.On the day of admission,PCT,CRP and conventional assessment scheme could all evaluate organ failure?P<0.05?.When the best threshold of PCT was 0.86ng/ml,the sensitivity and specificity were92.5%and 97.3%.?5?It was found that Only PCT and APACHEII could assess the need for ICU admission,The specificity of PCT with 5.85ng/ml as the best threshold was similar to that of APACHE II,both of which were 86.7%,while the specificity was not as good as that of APACHE II,which was only 66.7%.?6?Both PCT and the conventional evaluation schemes could evaluate the outcome of SAP patients.In the death group levels of PCT and the conventional evaluation schemes were higher on the day of death than that on the day of admission,In the survival group,levels of PCT and the conventional evaluation schemes were lower on the day of discharge than that on the day of admission,which showed a statistical difference?P<0.05?.At the end of the disease,each evaluation program could distinguish different outcomes of SAP patients.While on the day of admission,only PCT,APACHEII and BISAP could predict the outcome of SAP patients.The AUC of PCT was 0.75,and the sensitivity and specificity of PCT were 54.5%and 93.7%respectively when the threshold of PCT was 7.9ng/ml.Conclusion:This study showed that PCT and its dynamic change pattern have certain clinical application value in AP prognosis.Early in the disease,It could identify SAP?best on the day of admission?,determine the presence of organ failure,evaluate the need for admission to ICU,and predict the outcome of patients.