Table 1 Use of biomarkers for the diagnosis of infected necrosis secondary to acute pancreatitis

PCT/CRP

Rau B, [2]

Observational

61

Low

Comparison of PCT and CRP levels between 3 groups:

AUROC for the diagnosis of infected necrosis:

Oedematous pancreatitis (n = 22)

PCT (>1.8 mg/L) = 0.95 (Se: 95%, Sp: 88%),

Sterile necrosis (n = 18)

CRP (>300 mg/L) = 0.86 (Se:86%, Sp: 75%); p < 0.02

Infected necrosis (n = 21) according to imaging/surgery/microbiological data

PCT/CRP/GCSF

Muller CA, [3]

Observational

64

Low

Comparison of PCT, G-CSF, and CRP between patients having oedematous pancreatitis (n = 29)

AUROC for diagnosing infected necrosis:

CRP (>250) = 0.79 (Se: 83, Sp: 70%), PCT (0.45) = 0.77 (Se: 92%, Sp: 65%), AUC G-CSF (101) = 0.72 (Se: 92%, Sp: 48%)

Noninfected necrosis (n = 23)

Infected necrosis (n = 12) according to imaging/surgery/microbiological data

PCT/CRP/IL8

Rau B, [4]

Observational

50

Low

Comparison of PCT, IL8, and CRP levels between patients with:

AUROC for diagnosing infected necrosis:

Oedematous pancreatitis (n = 18)

CRP (>300) = 0.84 (Se: 83, Sp: 78%),

Non-infected necrosis (n = 14)

PCT (>1.8) = 0.97 (Se: 94%, Sp: 90%)

Infected necrosis (n = 18) according to imaging/surgery/microbiological data

IL-8 (112) = 0.78 (Se: 72%, Sp: 75%)

PCT/CRP/IL6/TNF

Riche F, [5]

Observational

48

Low

Comparison of PCT, IL-6, TNF-α, and CRP between patients having

AUROC for diagnosing infected necrosis:

- Noninfected necrosis (n = 33)

CRP = 0.76,

- Infected necrosis (n = 15), according to imaging/surgery/microbiological data

PCT = 0.78,

IL 6 = 0.77,

TNF α = 0.5

PCT

Purkayastha S, [6]

Literature review (5 studies)

206

Low

Assessing the value of PCT for diagnosing infected pancreatic necrosis

Threshold values for PCT vary from 0.48 to 2;

Sensitivity: 0.73 to 0.94

Specificity: 0.65 to 1

PCT/IL6/TNF/sTREM1

Lu Z, [7]

Observational

30

Low

Comparison of PCT, IL-6, TNF-α, and sTREM-1 levels in serum and drainage fluid between patients having:

Biomarker levels in drainage fluid: No difference between the two groups for CRP, TNF-α, and IL-6 levels

- Noninfected necrosis (n = 12), or

- sTREM1 (287), AUC = 0.97 (Se = 94, Sp = 92)

- Infected necrosis (n = 18), according to imaging/surgery/microbiological data

- PCT (2.1): AUC = 0.9 (Se = 86, Sp = 91).

Lower AUCs for serum levels:

PCT: 0.79; sTREM1: 0.73

PCT

Olah A, [8]

Observational

24

Low

Comparison of PCT levels in patients having

Serum PCT level >0.5 predicts infected necrosis with Se = 75% and Sp = 83%.

- Noninfected necrosis (n = 12)

Fine-needle aspiration predicts infection with Se = 92% and Sp = 100%.

- Infected necrosis (n = 12)

According to results of fine-needle aspiration and culture and surgery

PCT/IL6/sICAM1

Mandi Y, [9]

Observational

30

Low

Comparison of PCT, IL-6, and sICAM-1 between patients with

Only PCT (threshold >1 mg/L) allowed to distinguish patients with or without infected necrosis (Se = 90%; Sp = 100%).

Noninfected necrosis (n = 10)

Infected necrosis (n = 10), according to results of biopsy and culture.

PCT

Mofidi R, [1]

Literature review (7 studies)

264

Low

Assessment of PCT serum levels for the diagnosis of infected pancreatic necrosis

Threshold values vary from 0.48 to 3.5 mg/L, with a sensitivity of 0.63 to 0.92 and specificity of 0.71 to 0.97.

Summary table: infected necrosis in acute pancreatitis

Number of studies, n

Total number of patients, n

Highest level of evidence

Directness*

Consistency of results**

Overall strength of evidence

7

264^a

Low

Yes

Yes

Moderate