Abstract
Numerous diseases mimic appendicitis, and it is often difficult to rule it out on the basis of clinical presentation. Concentration of procalcitonin selectively increases in inflammatory conditions and determination of its level can help in the diagnosis of acute appendicitis. A prospective, single centre based observational study carried out at our tertiary care institute. Twenty eight patients were admitted with preliminary diagnosis of acute appendicitis. The control group involved around 12 healthy children. Serum Procalcitonin concentration was measured in all patients using the ‘Immunoluminometric Method’ (LUMI- Test PCT), besides carrying out clinical examination and other investigations. The serums PCT comes out to be a better diagnostic test than serum CRP measurement as serum PCT was able to differentiate patients who came with abdominal pain but were having normal appendix from the patients who were actual cases of acute appendicitis. In patients with histologically confirmed acute appendicitis the level of PCT was above the normal value of 0.5 ng/ml in most cases. The analysis of procalcitonin in different groups of patients showed the serum procalcitonin test having high sensitivity of 95.65% and a specificity of about 100% on the basis of histopathological diagnosis of the removed appendix taking as the standard. The serum procalcitonin test when combined with reliable clinical signs and symptoms is an excellent diagnostic marker of the disease and should be done in the patients of pediatric appendicitis so that proper handling of the patient can be done and we can prevent unnecessary appendectomies.
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References
Blomqvist PG, Andersson RE, Granath F et al (2001) Mortality after appendectomy in Sweden, 1987–1996. Ann Surg 233:455–460
Schwarz A, Bolke E, Peiper M et al (2007) Inflammatory peritoneal reaction after perforated appendicitis: continuous peritoneal lavage versus nonlavage. Eur J Med Res 12:200–205
Carrol ED, Thomson AP, Hart CA (2002) Procalcitonin as a marker of sepsis. Int J Antimicrob Agents 20:1–9
Fernandez A, Lluaces C, Garcia J et al (2003) Procalcitonin in pediatric emergency departments for the early diagnosis of invasive bacterial infections in febrile infants; results of a multicenter study and utility of a rapid qualitative test for this marker. Pediatr Infect Dis J 22(10):895–903
Kouame DB, Garrigue MA, Lardy H et al (2005) Is procalcitonin able to help in paediatric appendicitis diagnosis? Ann Chir 130(3):169–174
Delevaus I, Andre M, Colombier M et al (2003) Can procalcitonin measurement help in differentiating between bacterial infection and other kinds of inflammatory process? Ann Rehheum Dis 62:337–340
Muller B, White JC, Nylén ES et al. (2001) Ubiquitous expression of the calcitonin-I gene in multiple tissues in response to sepsis. J Clin Endocrinol Metab 86:396–404
Muller B, Becker KL (2001) Procalcitonin: how a hormone became a marker and mediator of sepsis. Swiss Med Wkly 131:595–602
Schwartz SL (1989) Principles of surgery, appendix, chapt 29, 5th edn. Mc Graw-Hill, New York, pp 1315–1326
Brunkhorst FM, Heinz U, Forycki ZF (1998) Kinetics of procalcitonin in iatrogenic sepsis. Intensive Care Med 24:888–892
Assicot M, Gendrel D, Carsin H et al (1993) High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 341:515–518
Steinbach G, Rau B, Debard AL et al (2004) Multicenter evaluation of a new immunoassay for procalcitonin measurement on the Kryptor System. Clin Chem Lab Med 42:440–449
Morgenthaler NG, Struck J, Fischer-Schulz C et al (2002) Detection of procalcitonin (PCT) in healthy controls and patients with local infection by a sensitive ILMA. Clin Lab 48:263–270
Jensen J, Heslet L, Jensen T et al (2006) Procalcitonin increase in early identification of critically ill patients at high risk of mortality. Crit Care Med 34:2596–2602
Hunziker S, Hugle T, Schuchardt K et al (2010) The value of serum procalcitonin level for differentiation of infectious from noninfectious causes of fever after orthopaedic surgery. J Bone Joint Surg Am 92:138–148
Chakhunashvili L, Inasaridze A, Svanidze S et al (2005) Procalcitonin as the biomarker of inflammation in diagnostics of pediatric appendicular peritonitis and for the prognosis of early postoperative complications. Georgian Med News 129:78–81
Chec’h C, Fosse JP, Karoubi P et al (2006) Differential diagnostic value of procalcitonin in surgical and medical patients with septic shock. Crit Care Med 34(1):102–107
Claeys R, Vinkeen S, Spapen H et al (2002) Plasma procalcitonin and C–reactive protein in acute septic shock: clinical and biological correlates. Crit Care Med 30(4):757–62
Kafetzis DA, Velissariou IM, Nikolaides P et al (2005) Procalcitonin as a predictor of severe appendicitis in children. Eur J Clin Microbiol Infect Dis 24:484–487
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We are very thankful to the Indian Council of Medical Research New Delhi for sponsoring and authenticating our Study.
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Chandel, V., Batt, S.H., Bhat, M.Y. et al. Procalcitonin as the Biomarker of Inflammation in Diagnosis of Appendicitis in Pediatric Patients and Prevention of Unnecessary Appendectomies. Indian J Surg 73, 136–141 (2011). https://doi.org/10.1007/s12262-010-0214-1
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DOI: https://doi.org/10.1007/s12262-010-0214-1