Diagnosis of infected pancreatic necrosis: A review of the role of blood biomarkers

Abstract

Infected pancreatic necrosis (IPN) is a serious and critical complication of acute pancreatitis (AP), often arising in the later stages of the disease. Early detection of high-risk individuals with IPN is essential because it may enable clinicians to implement more efficient management strategies. This review explores the key biomarkers currently used to predict and diagnose IPN. Established markers such as procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6) play a vital role in detecting infection and inflammation. Non-invasive markers, including corticosteroid-binding globulin (CBG), neutrophil CD64 index (nCD64), soluble PD-L1 (sPD-L1) and human leukocytes antigen-DR (HLA-DR), further contribute to identifying immune suppression and infection risks. While these tools show promise, no single biomarker has proven to be sufficiently accurate. A combination of clinical assessment, imaging and multiple biomarkers is essential for a comprehensive diagnosis. This review emphasizes the need for further research to refine and validate these markers, making them more accessible and reliable for routine clinical use. By advancing our ability to identify IPN early, we can improve patient outcomes and reduce the severe impacts of this complication in individuals suffering from AP.

Keywords: Acute necrotic pancreatitis; Biomarkers; C-reactive protein; Early diagnosis; Infected pancreatic necrosis; Interleukin-6; Neutrophil CD64 index; Procalcitonin; Severe acute pancreatitis.