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Procalcitonin as an excellent differential marker between uncomplicated and complicated acute appendicitis in adult patients

  • Yanxiu Li
  • Zhongwen Zhang
  • Iokfai Cheang
  • Xinli LiEmail author
Original Article
  • 32 Downloads

Abstract

Purpose

The aim of this study was to assay the variation of procalcitonin (PCT) in adult patients with uncomplicated and complicated acute appendicitis.

Methods

In total, 336 patients who underwent appendectomy from January 2016 to December 2017 were enrolled. Levels of inflammatory markers, the highest body temperature within the first 24 h of admission (BTm) and the duration of operation were recorded. All appendectomy specimens were sent for histopathological examination. According to the histopathological results, 336 patients who underwent appendectomy were divided into uncomplicated acute appendicitis (UAA) group (246 cases) and complicated acute appendicitis (CAA) group (90 cases) for further analysis. The relationships of procalcitonin (PCT) and related indicators with UAA and CAA were evaluated by receiver operating characteristic (ROC) and binary logistic regression analysis.

Results

Age, the levels of PCT, and CRP were significantly higher in CAA group (P < 0.05). Spearman correlation analysis showed that PCT was positively correlated with age (r = 0.452, P < 0.01) and CRP (r = 0.715, P < 0.01). The area under the curve (AUC) of PCT, CRP and age were 0.987, 0.902, and 0.748, respectively. ROC analysis showed when PCT > 0.42 ng/ml, it maximized the sensitivity and specificity. Logistic regression analysis indicated that PCT remained an independent risk factor for diagnosing CAA after adjusting with age and CRP (P < 0.05).

Conclusions

Serum PCT levels increased significantly in patients with CAA. PCT could provide convenient evaluation method for the optimal treatment of acute appendicitis.

Keywords

Procalcitonin (PCT) Complicated acute appendicitis (CAA) Treatment Appendectomy ROC curve 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest and have no relationships relevant to the contents of this paper to disclose.

References

  1. 1.
    Bhangu A, Søreide K, Di Saverio S, et al. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015;386(10000):1278–87.CrossRefGoogle Scholar
  2. 2.
    Loftus TJ, Dessaigne CG, Croft CA, et al. A protocol for non-operative management of uncomplicated appendicitis. J Trauma Acute Care Surg. 2018;84(2):358–64.CrossRefGoogle Scholar
  3. 3.
    Salminen P, Tuominen R, Paajanen H, et al. Five-year follow-up of antibiotic therapy for uncomplicated acute appendicitis in the APPAC randomized clinical trial. JAMA. 2018;320(12):1259–65.CrossRefGoogle Scholar
  4. 4.
    Huang L, Yin Y, Yang L, et al. Comparison of antibiotic therapy and appendectomy for acute uncomplicated appendicitis in children: a meta-analysis. JAMA Pediatr. 2017;171(5):426–34.CrossRefGoogle Scholar
  5. 5.
    Steiner Z, Buklan G, Stackievicz R, et al. Conservative treatment in uncomplicated acute appendicitis: reassessment of practice safety. Eur J Pediatr. 2017;176(4):521–7.CrossRefGoogle Scholar
  6. 6.
    Marc E, Ménager C, Moulin F, et al. Procalcitonin and viral meningitis: reduction of unnecessary antibiotics by measurement during an outbreak. Arch Pediatr. 2002;9(4):358–64.CrossRefGoogle Scholar
  7. 7.
    Christ-Crain M, Jaccard-Stolz D, Bingisser R, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial. Lancet. 2004;363(9409):600–7.CrossRefGoogle Scholar
  8. 8.
    Oláh A, Belágyi T, Issekutz A, et al. Value of procalcitonin quick test in the differentiation between sterile and infected forms of acute pancreatitis. Hepatogastroenterology. 2005;52(61):243–5.Google Scholar
  9. 9.
    Peschanski N, Chenevier-Gobeaux C, Mzabi L, et al. Prognostic value of PCT in septic emergency patients. Ann Intensive Care. 2016;6(1):47.CrossRefGoogle Scholar
  10. 10.
    Uzzan B, Cohen R, Nicolas P, et al. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Crit Care Med. 2006;34(7):1996–2003.CrossRefGoogle Scholar
  11. 11.
    Magrini L, Gagliano G, Travaglino F, et al. Comparison between white blood cell count, procalcitonin and C reactive protein as diagnostic and prognostic biomarkers of infection or sepsis in patients presenting to emergency department. Clin Chem Lab Med. 2014;52(10):1465–72.CrossRefGoogle Scholar
  12. 12.
    Jain S, Sinha S, Sharma SK, et al. Procalcitonin as a prognostic marker for sepsis: a prospective observational study. BMC Res Notes. 2014;7:458.CrossRefGoogle Scholar
  13. 13.
    Abbas MH, Choudhry MN, Hamza N, et al. Admission levels of serum amyloid a and procalcitonin are more predictive of the diagnosis of acute appendicitis compared with C-reactive protein. Surg Laparosc Endosc Percutan Tech. 2014;24(6):488–494.02.Google Scholar
  14. 14.
    Vaziri M, Ehsanipour F, Pazouki A, et al. Evaluation of procalcitonin as a biomarker of diagnosis, severity and postoperative complications in adult patients with acute appendicitis. Med J Islam Repub Iran. 2014;28:50.Google Scholar
  15. 15.
    Chandal V, Batt SH, Bhat MY, et al. Procalcitonin as the biomarker of inflammation in diagnosis of appendicitis in pediatric patients and prevention of unnecessary appendectomies. Indian J Surg. 2011;73(2):136–41.CrossRefGoogle Scholar
  16. 16.
    Assarsson J, Körner U, Lundholm K. Evaluation of procalcitonin as a marker to predict antibiotic response in adult patients with acute appendicitis: a prospective observational study. Surg Infect (Larchmt). 2014;15(5):601–5.CrossRefGoogle Scholar
  17. 17.
    Yu CW, Juan LI, Wu MH, et al. Systematic review and meta-analysis of the diagnostic accuracy of procalcitonin, C-reactive protein and white blood cell count for suspected acute appendicitis. Br J Surg. 2013;100(3):322–9.CrossRefGoogle Scholar
  18. 18.
    Salminen P, Paajanen H, Rautio T, et al. Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: the APPAC randomized clinical trial. JAMA. 2015;313(23):2340–8.CrossRefGoogle Scholar
  19. 19.
    Acharya A, Markar SR, Ni M, et al. Biomarkers of acute appendicitis: systematic review and cost-benefit trade-off analysis. Surg Endosc. 2017;31(3):1022–31.CrossRefGoogle Scholar
  20. 20.
    Bal A, Anil M, Nartürk M, et al. Importance of clinical decision making by experienced pediatric surgeons when children are suspected of having acute appendicitis: the reality in a high-volume pediatric emergency department. Pediatr Emerg Care. 2017;33(9):e38–42.CrossRefGoogle Scholar
  21. 21.
    Benito J, Acedo Y, Medrano L, et al. Usefulness of new and traditional serum biomarkers in children with suspected appendicitis. Am J Emerg Med. 2016;34(5):871–6.CrossRefGoogle Scholar
  22. 22.
    Kaya B, Sana B, Eris C, et al. The diagnostic value of D-dimer, procalcitonin and CRP in acute appendicitis. Int J Med Sci. 2012;9(10):909–15.CrossRefGoogle Scholar
  23. 23.
    Anielski R, Kuśnierz-Cabala B, Szafraniec K. An evaluation of the utility of additional tests in the preoperative diagnostics of acute appendicitis. Langenbecks Arch Surg. 2010;395(8):1061–8.CrossRefGoogle Scholar
  24. 24.
    Keskek M, Tez M, Yoldas O, et al. Receiver operating characteristic analysis of leukocyte counts in operations for suspected appendicitis. Am J Emerg Med. 2008;26(7):769–72.CrossRefGoogle Scholar
  25. 25.
    Kwan KY, Nager AL. Diagnosing pediatric appendicitis: usefulness of laboratory markers. Am J Emerg Med. 2010;28(9):1009–15.CrossRefGoogle Scholar
  26. 26.
    Jekarl DW, Lee SY, Lee J, et al. Procalcitonin as a diagnostic marker and IL-6 as a prognostic marker for sepsis. Diagn Microbiol Infect Dis. 2013;75(4):342–7.CrossRefGoogle Scholar
  27. 27.
    Taylor R, Jones A, Kelly S, et al. A review of the value of procalcitonin as a marker of infection. Cureus. 2017;9(4):e1148.Google Scholar
  28. 28.
    Müller B, White JC, Nylén ES, et al. Ubiquitous expression of the calcitonin-i gene in multiple tissues in response to sepsis. J Clin Endocrinol Metab. 2001;86(1):396–404.Google Scholar
  29. 29.
    Müller B, Becker KL. Procalcitonin: how a hormone became a marker and mediator of sepsis. Swiss Med Wkly. 2001;131(41–42):595–602.Google Scholar
  30. 30.
    Cho SY, Choi JH. Biomarkers of sepsis. Infect Chemother. 2014;46(1):1–12.CrossRefGoogle Scholar
  31. 31.
    Khan AN, Sawan A, Likourezos A, et al. The usefulness of procalcitonin in the diagnosis of appendicitis in children: a pilot study. Emerg Med Int. 2012;2012:317504.CrossRefGoogle Scholar
  32. 32.
    Chakhunashvili L, Inasaridze A, Svanidze S, et al. Procalcitonin as the biomarker of inflammation in diagnostics of pediatric appendicular peritonitis and for the prognosis of early postoperative complications. Georgian Med News. 2005;129:78–81.Google Scholar
  33. 33.
    Kouame DB, Garrigue MA, Lardy H, et al. Is procalcitonin able to help in pediatric appendicitis diagnosis? Ann Chir. 2005;130(3):169–74.CrossRefGoogle Scholar
  34. 34.
    Gavela T, Cabeza B, Serrano A, et al. C-reactive protein and procalcitonin are predictors of the severity of acute appendicitis in children. Pediatr Emerg Care. 2012;28(5):416–9.CrossRefGoogle Scholar
  35. 35.
    Kafetzis DA, Velissariou IM, Nikolaides P, et al. Procalcitonin as a predictor of severe appendicitis in children. Eur J Clin Microbiol Infect Dis. 2005;24(7):484–7.CrossRefGoogle Scholar
  36. 36.
    Blab E, Kohlhuber U, Tillawi S, et al. Advancements in the diagnosis of acute appendicitis in children and adolescents. Eur J Pediatr Surg. 2004;14(6):404–9.CrossRefGoogle Scholar
  37. 37.
    Sand M, Trullen XV, Bechara FG, et al. A prospective bicenter study investigating the diagnostic value of procalcitonin in patients with acute appendicitis. Eur Surg Res. 2009;43(3):291–7.CrossRefGoogle Scholar
  38. 38.
    Wu JY, Chen HC, Lee SH, et al. Diagnostic role of procalcitonin in patients with suspected appendicitis. World J Surg. 2012;36(8):1744–9.CrossRefGoogle Scholar
  39. 39.
    Tanrıkulu CŞ, Karamercan MA, Tanrıkulu Y, et al. The predictive value of Alvarado score, inflammatory parameters and ultrasound imaging in the diagnosis of acute appendicitis. Ulus Cerrahi Derg. 2015;32(2):115–21.Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Yanxiu Li
    • 1
    • 2
  • Zhongwen Zhang
    • 3
  • Iokfai Cheang
    • 1
  • Xinli Li
    • 1
    Email author
  1. 1.Department of CardiologyFirst Affiliated Hospital with Nanjing Medical UniversityNanjingChina
  2. 2.ICUFirst Affiliated Hospital with Nanjing Medical UniversityNanjingChina
  3. 3.Department of General SurgeryThe Affiliated Jiangning Hospital of Nanjing Medical UniversityNanjingChina

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