Erythrocyte sedimentation rate and C-reactive protein for the prediction of severity of acute pancreatitis

Objectives: To investigate the performance of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) for predicting severe acute pancreatitis (AP). Methods: Fifty patients with AP were prospectively enrolled. Erythrocyte sedimentation rate and CRP were measured at admission and every 12 hours for 48 hours after admission. Results: The patients' mean age was 50 ± 2.2 years, 64% were male, and 30% developed severe AP. Patients with severe AP had higher levels of ESR (77 ± 4.7 vs 50 ± 4.8 mm/h; P = 0.002) and CRP (218 ± 30.7 vs 97 ± 12.1 mg/L; P <0.001) at 36 hours after admission compared with those with mild AP. Erythrocyte sedimentation rates of 60 mm/h or greater predict severe AP at 36 hours with a sensitivity, specificity, and positive and negative predictive values of 86%, 57%, and 48% and 90%, whereas CRP of 150 mg/L or greater provided the results of 86%, 87%, and 75% and 93%, respectively. Elevation of either ESR or CRP at 24 hours increased the sensitivity and negative predictive value to 100%, and elevation of both ESR and CRP increased the specificity and PPV to 100%. Conclusions: Erythrocyte sedimentation rate can predict severe AP with a slightly inferior performance to CRP. Combined ESR and CRP at 24 hours can predict severe AP accurately.