Serum calprotectin in infected pancreatic necrosis

Introduction: Calprotectin (Cal) is a calcium-binding protein secreted predominantly by neutrophils and monocytes. Serum Cal level is known to be elevated in patients with acute pancreatitis, but it is thought not to be a useful marker for early prediction of severity of pancreatitis. The aim of the present study is to evaluate the role of serum Cal in the prediction of infected acute necrotizing pancreatitis. Patients and Methods: Between November 2011 and February 2013 patients with acute necrotizing pancreatitis admitted to our clinic were recruited. Additionally positive controls with edematous pancreatitis or sepsis and healthy negative controls were enrolled into the study. Serum samples were prospectively taken for the measurement of Cal, procalcitonin (PCT), C-reactive protein (CRP) and white blood cell (WBC) count. The presence of necrosis was established with abdominal computed tomography (CT), the occurrence of infection was revealed with ultrasound-guided fine needle aspiration and culture or with air bubbles seen on abdominal CT scan. Results: 13 patients treated with acute necrotizing pancreatitis were recruited in the study (11 male, 2 female, mean age: 50.3 ± 18.8 y, range: 34 – 77 y). The serum Cal level on the first day of admission differed significantly between the groups of infected necrosis and necrotizing acute pancreatitis (p < 0.006) and between the group of infected necrosis and acute edematous pancreatitis (p < 0.03); however there was no significant difference between necrotizing acute pancreatitis and edematous acute pancreatitis. Analyzing the time-course changes of the inflammatory parameters, in 70% of the cases Cal was the marker which elevated first. In 86% of the patients Cal elevation was followed by the increase in CRP level, while WBC count and/or PCT were slightly elevated or normal.

Conclusion: Serum Cal is elevated in acute pancreatitis, but it is not able to differentiate between edematous and necrotizing pancreatitis. Cal determination may be a useful marker to predict infected necrosis. Further cases are needed to evaluate its role in the diagnosis.