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Corticosteroid-binding globulin: A possible early predictor of infection in acute necrotizing pancreatitis

Muller, Christophe A.; Belyaev, Orlin; Vogeser, Michael; Weyhe, Dirk; Gloor, Beat; Strobel, Oliver; Werner, Jens; Borgström, Anders LU ; Buchler, Markus W. and Uhl, Waldemar (2007) In Scandinavian Journal of Gastroenterology 42(11). p.1354-1361
Abstract
Objective. Infected pancreatic necrosis is the main cause of death in patients with acute pancreatitis, and therefore its early prediction is of utmost importance. Endogenous cortisol metabolism plays a basic role both in the course of acute pancreatitis and in the process of infection. The purpose of this study was to analyze corticosteroid-binding globulin (CBG), total cortisol, calculated free cortisol and adrenocorticotropic hormone as potential early predictors in order to differentiate between infected pancreatic necrosis and sterile pancreatic necrosis in patients with acute pancreatitis. Material and methods. Serum levels of CBG, total cortisol, calculated free cortisol, and plasma levels of adrenocorticotropic hormone were... (More)
Objective. Infected pancreatic necrosis is the main cause of death in patients with acute pancreatitis, and therefore its early prediction is of utmost importance. Endogenous cortisol metabolism plays a basic role both in the course of acute pancreatitis and in the process of infection. The purpose of this study was to analyze corticosteroid-binding globulin (CBG), total cortisol, calculated free cortisol and adrenocorticotropic hormone as potential early predictors in order to differentiate between infected pancreatic necrosis and sterile pancreatic necrosis in patients with acute pancreatitis. Material and methods. Serum levels of CBG, total cortisol, calculated free cortisol, and plasma levels of adrenocorticotropic hormone were determined in 109 consecutive patients with acute pancreatitis. C-reactive protein was measured as the control parameter. Thirty-five patients developed necrotizing pancreatitis and 10 developed infection of the necrosis. Blood was monitored for 6 days after the onset of pain; 30 healthy individuals served as controls. Results. Of all parameters only CBG showed a significant difference ( p = 0.0318) in its peak levels measured in the first 48 h in patients with sterile (26.5 mu g/ml, range 21.3-34.7) and infected (16.0 mu g/ml, range 15.2-25.0) necrosis at a cut-off level of 16.8 mu g/ml. That difference was further preserved for the first 6 days after onset of pain. Conclusions. In our group of patients, a decreased CBG level below 16.8 g/ml within the initial 48 h of acute pancreatitis was an early predictor of later infected pancreatic necrosis, with a positive predictive value of 100% and a negative predictive value of 87.5%. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
acute necrotizing pancreatitis, corticosteroid-binding globulin, predictors of infection
in
Scandinavian Journal of Gastroenterology
volume
42
issue
11
pages
1354 - 1361
publisher
Taylor & Francis
external identifiers
  • wos:000249956200012
  • scopus:35148842614
ISSN
1502-7708
DOI
10.1080/00365520701416691
language
English
LU publication?
yes
id
3a40b222-a999-4e2f-99ea-4d8672d56d90 (old id 653348)
date added to LUP
2007-12-14 13:48:58
date last changed
2017-01-01 06:36:48
@article{3a40b222-a999-4e2f-99ea-4d8672d56d90,
  abstract     = {Objective. Infected pancreatic necrosis is the main cause of death in patients with acute pancreatitis, and therefore its early prediction is of utmost importance. Endogenous cortisol metabolism plays a basic role both in the course of acute pancreatitis and in the process of infection. The purpose of this study was to analyze corticosteroid-binding globulin (CBG), total cortisol, calculated free cortisol and adrenocorticotropic hormone as potential early predictors in order to differentiate between infected pancreatic necrosis and sterile pancreatic necrosis in patients with acute pancreatitis. Material and methods. Serum levels of CBG, total cortisol, calculated free cortisol, and plasma levels of adrenocorticotropic hormone were determined in 109 consecutive patients with acute pancreatitis. C-reactive protein was measured as the control parameter. Thirty-five patients developed necrotizing pancreatitis and 10 developed infection of the necrosis. Blood was monitored for 6 days after the onset of pain; 30 healthy individuals served as controls. Results. Of all parameters only CBG showed a significant difference ( p = 0.0318) in its peak levels measured in the first 48 h in patients with sterile (26.5 mu g/ml, range 21.3-34.7) and infected (16.0 mu g/ml, range 15.2-25.0) necrosis at a cut-off level of 16.8 mu g/ml. That difference was further preserved for the first 6 days after onset of pain. Conclusions. In our group of patients, a decreased CBG level below 16.8 g/ml within the initial 48 h of acute pancreatitis was an early predictor of later infected pancreatic necrosis, with a positive predictive value of 100% and a negative predictive value of 87.5%.},
  author       = {Muller, Christophe A. and Belyaev, Orlin and Vogeser, Michael and Weyhe, Dirk and Gloor, Beat and Strobel, Oliver and Werner, Jens and Borgström, Anders and Buchler, Markus W. and Uhl, Waldemar},
  issn         = {1502-7708},
  keyword      = {acute necrotizing pancreatitis,corticosteroid-binding globulin,predictors of infection},
  language     = {eng},
  number       = {11},
  pages        = {1354--1361},
  publisher    = {Taylor & Francis},
  series       = {Scandinavian Journal of Gastroenterology},
  title        = {Corticosteroid-binding globulin: A possible early predictor of infection in acute necrotizing pancreatitis},
  url          = {http://dx.doi.org/10.1080/00365520701416691},
  volume       = {42},
  year         = {2007},
}