calca-protein--human and Cholangitis

It is important to identify biomarkers for sepsis and organ damage in acute cholangitis patients. We investigated the usefulness of procalcitonin (PCT) as a biomarker of inflammation based on the Tokyo Guidelines 2013 (TG13).. A total of 110 acute cholangitis patients were categorized based on TG13, and the PCT levels and common laboratory inflammatory markers were measured. The cases undergoing hemoculture (n = 72) at the time of diagnosis also correlated with the PCT levels.. The PCT and C-reactive protein levels were significantly higher in grade III cases versus grade I. The mean PCT levels for positive hemoculture cases (8.6 ng/ml) were significantly higher than those for negative cases (0.7 ng/ml). In hemoculture positive cases or when purulent bile was obtained from the duodenal papilla, i.e., cases clearly requiring emergency biliary drainage and necessitating categorization as grade III, three cases were categorized as grade I and 13 as grade II. Only PCT showed statistically significant increases in severe cases underestimated as grade I or II despite them being fundamentally grade III cases.. Acute cholangitis with high PCT levels can signify the need to perform emergency biliary drainage and institute intensive care even if categorized by TG13 as not being severe cases.

Topics: Acute Disease; Aged; Aged, 80 and over; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cholangitis; Diagnostic Imaging; Drainage; Emergencies; Female; Humans; Liver Function Tests; Male; Middle Aged; Protein Precursors; Severity of Illness Index; Treatment Outcome

The aim of the present study was to examine the usability of procalcitonin (PCT) for severity assessment in patients with acute cholangitis (AC).. Serum PCT concentrations were measured on admission in patients with AC. Patients were classified with mild, moderate, or severe AC based on severity assessment guidelines.. We included 159 treatment-naïve patients with AC (95 males, 64 females) in this study. The median PCT concentrations were 0.08 ng/mL (interquartile range (IQR) 0.04 - 0.18 ng/mL), 0.37 ng/mL (IQR 0.15 - 1.85 ng/mL), and 5.56 ng/mL (IQR 3.59 - 25.89 ng/mL) in patients with mild, moderate and severe AC, respectively. PCT concentrations were significantly higher in patients with severe AC than in patients with moderate AC (p < 0.0001), and in patients with moderate AC than in patients with mild AC (p < 0.0001). The areas under the receiver operating characteristic curves for PCT to discriminate patients with moderate and severe AC were 0.84 (95% CI 0.77 to 0.92, p < 0.001) and 0.86 (95% CI 0.78 to 0.92, p < 0.001), respectively.. Serum PCT concentrations were elevated in patients with AC and may be a useful parameter for the severity assessment of AC.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Calcitonin; Calcitonin Gene-Related Peptide; Cholangitis; Female; Humans; Male; Middle Aged; Protein Precursors; Retrospective Studies; ROC Curve; Severity of Illness Index

Analysis of the examination and treatment results was conducted in 92 patients, suffering the obturation jaundice syndrome. There was elaborated a diagnostic program, in which the existing diagnostic standard for obturation jaundice and its complicated forms, an acute cholangitis and biliary sepsis, was added by determination of the blood procalcitonin level, microbiological investigation of the blood and bile, the bile microscopy, the analysis of the system inflammatory response syndrome signs and the organs dysfunction (according to SOFA scale). The program introduction have permitted to perform differential diagnosis of uncomplicated--in 30 (32.6%) patients, and complicated--in 42 (45.7%) obturation jaundice in an acute cholangitis and in 20 (21.7%)--in biliary sepsis. The treatment program is characterized by differentiated approach, depending on the disease kind, and includes the conduction of urgent decompression and sanation of biliary ducts. The method and volume of complex conservative therapy have differed essentially in patients, suffering obturation jaundice, an acute cholangitis and biliary sepsis.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Bile; Bile Ducts; Calcitonin; Calcitonin Gene-Related Peptide; Cholangitis; Decompression, Surgical; Diagnosis, Differential; Disease Management; Female; Humans; Jaundice, Obstructive; Male; Microscopy; Middle Aged; Minimally Invasive Surgical Procedures; Protein Precursors; Sepsis

The distinctions and interrelationship were established between acute cholangitis and biliary sepsis. Patients with hyperbilirubinemia were divided into four groups according to the developed criteria of inclusion and of using a new strategy of treatment for each group. It determined the result of treatment, i.e. resulted in lower lethality, shorter stay at hospital, less cost of treatment. One of the main criteria for the inclusion into a certain group was considered to be the index of blood plasma procalcitonin.

Topics: Acute Disease; Bile Ducts; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cholangitis; Decompression, Surgical; Follow-Up Studies; Glycoproteins; Humans; Protein Precursors; Retrospective Studies; Sepsis