Monitoring procalcitonin is of value in acute pancreatitis
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《英国医生杂志》
EDITOR—In their discussion of the important issue of antibiotic prophylaxis in acute pancreatitis, I was surprised that O'Reilly and Kingsnorth made no mention of monitoring the plasma concentration of procalcitonin.1 A considerable literature now exists, establishing the value of procalcitonin monitoring in acute pancreatitis,2-4 and it is our practice to use the APACHE II score and the value of this inflammatory marker to guide the requirement for early antibiotic prophylaxis with a carbipenem and fluconazole.
A recent study has shown that the plasma concentration of procalcitonin may reflect the derangement in gut barrier function (rather than the extent of systemic inflammation) and may hence predict those patients in whom the translocation of bacteria and fungi into dead pancreas is more likely.5
I agree with the authors that we do not want to give all patients with acute pancreatitis antibiotic prophylaxis. But I have experience of fatal acute pancreatitis from untreated Gram negative sepsis because of too "purist" an approach. The issue in my mind is how to identify the patients at risk early on and then include both bacterial and fungal prophylaxis.
David Bihari, associate professor
University of New South Wales Lismore Base Hospital, Lismore, NSW 2480, Australia biharid@aol.com
Competing interests: None declared.
References
O'Reilly DA, Kingsnorth AN. Management of acute pancreatitis. BMJ 2004;328: 968-9. (24 April.)
Rau B, Steinbach G, Gansauge F, Mayer JM, Grunert A, Beger HG. The potential role of procalcitonin and interleukin 8 in the prediction of infected necrosis in acute pancreatitis. Gut 1997;41: 832-40
Kylanpaa-Back M-L, Takala A, Kemppainen EA, Puolakkainen PA, Leppaniemi AK, Karonen S-L, et al. Procalcitonin, soluble interleukin-2 receptor and soluble E-selectin in predicting the severity of acute pancreatitis. Crit Care Med 2001;29: 63-9.
Ammori BJ, Becker KL, Kite P, Snider RH, Nylen ES, White JC, Larvin M, et al. Calcitonin precursors in the prediction of severity of acute pancreatitis on the day of admission. Br J Surg 2003;90: 197-204.
Ammori BJ, Becker KL, Kite P, Snider RH, Nylen ES, White JC, et al. Calcitonin precursors: early markers of gut barrier dysfunction in patients with acute pancreatitis. Pancreas 2003:27: 239-43.
A recent study has shown that the plasma concentration of procalcitonin may reflect the derangement in gut barrier function (rather than the extent of systemic inflammation) and may hence predict those patients in whom the translocation of bacteria and fungi into dead pancreas is more likely.5
I agree with the authors that we do not want to give all patients with acute pancreatitis antibiotic prophylaxis. But I have experience of fatal acute pancreatitis from untreated Gram negative sepsis because of too "purist" an approach. The issue in my mind is how to identify the patients at risk early on and then include both bacterial and fungal prophylaxis.
David Bihari, associate professor
University of New South Wales Lismore Base Hospital, Lismore, NSW 2480, Australia biharid@aol.com
Competing interests: None declared.
References
O'Reilly DA, Kingsnorth AN. Management of acute pancreatitis. BMJ 2004;328: 968-9. (24 April.)
Rau B, Steinbach G, Gansauge F, Mayer JM, Grunert A, Beger HG. The potential role of procalcitonin and interleukin 8 in the prediction of infected necrosis in acute pancreatitis. Gut 1997;41: 832-40
Kylanpaa-Back M-L, Takala A, Kemppainen EA, Puolakkainen PA, Leppaniemi AK, Karonen S-L, et al. Procalcitonin, soluble interleukin-2 receptor and soluble E-selectin in predicting the severity of acute pancreatitis. Crit Care Med 2001;29: 63-9.
Ammori BJ, Becker KL, Kite P, Snider RH, Nylen ES, White JC, Larvin M, et al. Calcitonin precursors in the prediction of severity of acute pancreatitis on the day of admission. Br J Surg 2003;90: 197-204.
Ammori BJ, Becker KL, Kite P, Snider RH, Nylen ES, White JC, et al. Calcitonin precursors: early markers of gut barrier dysfunction in patients with acute pancreatitis. Pancreas 2003:27: 239-43.