Diagnostic role of procalcitonin in patients with suspected appendicitis

Jiunn Yih Wu, Hang Cheng Chen, Si Huei Lee, Rai Chi Chan, Chien Chang Lee, Shy Shin Chang

Research output: Contribution to journalArticle

22 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1744-1749
Number of pages6
JournalWorld Journal of Surgery
Volume36
Issue number8
DOIs
Publication statusPublished - Aug 1 2012
Externally publishedYes

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Calcitonin
Appendicitis
Hospital Emergency Service
C-Reactive Protein
Cellulitis
Gangrene
Observational Studies
Biomarkers
Tomography
Prospective Studies

ASJC Scopus subject areas

  • Surgery

Cite this

Diagnostic role of procalcitonin in patients with suspected appendicitis. / Wu, Jiunn Yih; Chen, Hang Cheng; Lee, Si Huei; Chan, Rai Chi; Lee, Chien Chang; Chang, Shy Shin.

In: World Journal of Surgery, Vol. 36, No. 8, 01.08.2012, p. 1744-1749.

Research output: Contribution to journalArticle

Wu, Jiunn Yih ; Chen, Hang Cheng ; Lee, Si Huei ; Chan, Rai Chi ; Lee, Chien Chang ; Chang, Shy Shin. / Diagnostic role of procalcitonin in patients with suspected appendicitis. In: World Journal of Surgery. 2012 ; Vol. 36, No. 8. pp. 1744-1749.
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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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AB - 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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