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Diagnostic Role of Procalcitonin in Patients with Suspected Appendicitis

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Abstract

Background

The aim of this study was to assess the diagnostic value of procalcitonin (PCT) in emergency department (ED) patients with suspected appendicitis.

Methods

A prospective observational study was carried out inthe emergency department of a university hospital between July 2007 and June 2008. Adult patients who presented to the ED with clinically suspected appendicitis were enrolled. Each patient underwent serum PCT, C-reactive protein (CRP), and Alvarado score evaluation on admission. The results of these three measurements were analyzed in relation to the final diagnosis determined by histopathological findings or compatible computed tomography findings.

Results

Of the 214 study patients, 113 (52.8 %) had a confirmed diagnosis of appendicitis and 58 had complicated appendicitis (phlegmon, perforation, or gangrene). For the diagnosis of appendicitis, the area under the receiving operating characteristic (ROC) curve is 0.74 for Alvarado score, 0.69 for PCT, and 0.61 for CRP. Overall, the Alvarado score has the best discriminative capability among the three tested markers. We adopted two cutoff point approaches to harness both ends of the diagnostic value of a biomarker. PCT levels were significantly higher in patients with complicated appendicitis. For diagnosis of complicated appendicitis, a cutoff value of 0.5 ng/mL had a sensitivity of 29 % and a specificity of 95 %, while a cutoff value of 0.05 ng/ml had a sensitivity of 85 % and a specificity of 30 % in diagnosing complicated appendicitis. For those with a PCT value in the gray zone, clinical findings may play a more important role.

Conclusion

The study does not support the hypothesis that the PCT test may be useful for screening ED patients for appendicitis. However, determination of the PCT level may be useful for risk assessment of ED patients with suspected complicated appendicitis.

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Conflict of interest

The authors have no conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan

    Jiunn-Yih Wu & Hang-Cheng Chen

  2. Chang Gung University College of Medicine, Taoyuan, No. 222, Maijin Road, Keelung City, 20401, Taiwan

    Jiunn-Yih Wu & Hang-Cheng Chen

  3. Department of Rehabilitation and Physical Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Si-Huei Lee & Rai-Chi Chan

  4. Department of Rehabilitation and Physical Medicine, National Yang-Ming University, Taipei, Taiwan, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan

    Si-Huei Lee & Rai-Chi Chan

  5. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    Chien-Chang Lee

  6. Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, No. 579, Sec. 2, Yunlin Road, Douliou, 640, Taiwan

    Chien-Chang Lee

  7. Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Shy-Shin Chang

  8. Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, No. 5, Fusing St., Gueishan Township, Taoyuan County, 333, Taiwan

    Shy-Shin Chang

Authors
  1. Jiunn-Yih Wu
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  2. Hang-Cheng Chen
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  3. Si-Huei Lee
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  4. Rai-Chi Chan
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Corresponding authors

Correspondence to Chien-Chang Lee or Shy-Shin Chang.

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Wu, JY., Chen, HC., Lee, SH. et al. Diagnostic Role of Procalcitonin in Patients with Suspected Appendicitis. World J Surg 36, 1744–1749 (2012). https://doi.org/10.1007/s00268-012-1579-z

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  • DOI: https://doi.org/10.1007/s00268-012-1579-z

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