Evaluation of procalcitonin as a biomarker of diagnosis, severity and postoperative complications in adult patients with acute appendicitis

Authors

  • Abdolreza Pazouki Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.
  • Fahimeh Ehsanipour Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran.
  • Fatemeh Jesmi Minimally Invasive Surgery Research center, Iran University of Medical Sciences, Tehran, Iran.
  • Mohammad Vaziri Minimally Invasive Surgery Research center, Iran University of Medical Sciences, Tehran, Iran.
  • Shahla Chaichian Director of Minimally Invasive Techniques Research Center, Islamic Azad University, Tehran Medical Unit, Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran.
  • Zeinab Tamannaie Minimally Invasive Surgery Research center, Iran University of Medical Sciences, Tehran, Iran.
Abstract:

  Background :Delay in diagnosis and treatment of acute appendicitis (AA) results in an increased rate of perforation, postoperative morbidity, mortality and hospital length of stay. Several biochemical parameters including white blood cell (WBC) count, C-reactive protein (CRP), interleukin-6 (IL6) and Procalcitonin (PCT) have been used to further improve the clinical diagnosis of AA. The aim of this study was to assess the value of procalcitonin as a predictor of diagnosis and severity of appendicitis in order to improve the clinical decision making, since other studies have been unable to demonstrate a diagnostic value for PCT elevation in acute appendicitis.   Methods: One-hundred patients who underwent open appendectomy, including 75 men and 25 women with a mean age of 28 years were included in this study. Procalcitonin values were measured by an immunofluorescent method). Serum PCT>0.5 ng/ml was considered positive. The PCT serum values were measured in four different categories, including ˂0.5ng/ml, 0.5-2 ng/ml, 2-10ng/ml and more than 10ng/ml.   Results: The sensitivity and specificity of PCT level measurement for acute appendicitis diagnosis were 44% and 100% respectively. The value of PCT increased with the severity of appendicitis and also with the presence of peritonitis and infection, at the site of surgery.   Conclusions: Procalcitonin measurement cannot be used as a diagnostic test for adult patients with acute appendicitis and its routine use in such patients is not cost effective and conclusive. Procalcitonin values can be used as a prognostic marker and predictor of infectious complications following surgery and it can help to carry out timely surgical intervention which is highly recommended in patients with PCT values more than 0.5ng/ml.  

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Journal title

volume 28  issue 1

pages  309- 314

publication date 2014-01

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