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

From: Role of biomarkers in the management of antibiotic therapy: an expert panel review II: clinical use of biomarkers for initiation or discontinuation of antibiotic therapy

Marker Study Study design Nb of patients, n Level of evidence Biomarker tested and groups compared Main results
1 st author, [Ref]
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 264a Low Yes   Yes Moderate
  1. aNumber of patients included in diagnostic studies of infected pancreatic necrosis.
  2. *Directness: studies provide evidence of a direct association between a treatment or a given risk factor and a judgment criterion.
  3. **Consistency: results from studies of similar level of evidence are not contradictory.