The clinical value of the procalcitonin in prediction of severity and outcome in acute pancreatitis.

BACKGROUND/AIMS: Early identification of patients with severe forms of acute pancreatitis (AP) and subsequent management of these high risk patients are the most important aims in order to decrease mortality from AP. Procalcitonin (PCT) as a marker for systemic inflammation appears to be a useful marker for early identification of severe forms. METHODOLOGY: 101 patients with confirmed AP have been admitted to department of general surgery. PCT values were measured in each patient on admission and after 12 hours. PCT levels were correlated to the disease's course and prognosis. Results are given through PPV and NPV. Immunoluminometric assay (BRAHMS Diagnostica) was used for measurement. RESULTS: PPV and NPV for prediction of disease's course were better for PCT than for CRP PPV 64.7% versus 36% and NPV 82,6% versus 79.6% and for prediction of fatal outcome PCT reached 75% and 100% for cut off value 5 ng/ml. CONCLUSIONS: PCT seems to be a useful screening parameter for detecting severe AP and for identifying the patients who need ICU treatment, ATB covering and who can benefit from the novel therapies.

Cytokine levels in patients with a very low left ventricular ejection fraction after open heart surgery.

INTRODUCTION: Cardiopulmonary bypass and cardiac operations are obligatorily connected with systemic inflammatory reaction. Production of proinflammatory cytokines is responsible also for negative effects on the myocardial function. OBJECTIVE OF STUDY: Follow-up of the dynamic changes of proinflammatory and antiinflammatory cytokine levels in patients with left ventricular dysfunction during the first week after cardiac surgery. PATIENTS AND METHODS: A total of nine patients with a very low left ventricular ejection fraction (22.75 +/- 0.65%) who had undergone cardiac surgery (for coronary artery bypass grafting or aortic valve reconstruction) were investigated during the first after week operation. The preoperative and postoperative plasma levels of tumor necrosis factor (TNF), interleukin-8 (IL-8) and interleukin-10 (IL-10) were estimated by means of ELISA technique. RESULTS: With respect to the preoperative levels, on the first postoperative day the levels IL-8 (from 9.36 to 16.65 pg/ml) (p < 0.05) and of IL-10 (from 6.93 to 28.09 pg/ml) (p < 0.02) significantly rose with a stepwise decrease down to the seventh day after surgery. From the third to seventh day an insignificant increase in TNF level was also noted. CONCLUSIONS: The results have shown that open heart surgery in patients with a severe left ventricular dysfunction evoked a systemic inflammatory response demonstrated by early increase in proinflammatory cytokine IL-8 and was accompanied by increased level of antiinflammatory cytokine IL-10. Despite stepwise decrease in IL-8 levels, they did not reach the preoperative levels, not even on the seventh postoperative day. (Tab. 1, Fig. 3, Ref. 21.)

[Serum cystatin C in haemodialysed patients]. / Cystatín C v sére u hemodialyzovaných pacientov.

BACKGROUND: Cystatin C (CyC) is protein (m. w. 13 300), which is produced by nucleated cells, filtered through glomeruli and subsequently reabsorbed and degraded in tubuli. OBJECTIVE: To investigate changes in serum CyC concentration during two low-flux membrane haemodialyses (HD-I, HD-II) and relationship between serum CyC a creatinine concentrations. PATIENTS AND METHODS: Serum CyC was determined in 17 patients on chronic haemodialysis during HD-I and HD-II by immunonephelometric method (Dade Behring, Austria). RESULTS: Significant correlation between serum CyC and creatinine before HD-I and before/after HD-II was found (p < 0.001). Serum CyC before HD-I (median 6.3 mg/I, 95 % CI 5.5 - 6.7) increased after HD-I (7.1 mg/l, 6.1 - 8.9) (p < 0.001). Serum CyC before HD-II (6.4 mg/l, 5.8 - 7.2) increased after HD-II (8.0 mg/l, 7.3 - 9) (p < 0.001), while serum creatinine decreased after HD-I and HD-II (p < 0.001). There was correlation between the increase in serum CyC and albumin during HD-I (p < 0.001) and HD-II (p < 0.01). CONCLUSION: There was close correlation between serum CyC and creatinine before haemodialyses. Serum CyC increased after haemodialyses, due to CyC non-dialysability through low-flux membrane and haemoconcentration. Unlike creatininaemia, serum CyC reflects the residual renal function even after haemodialyses.