A Prospective Bicenter Study Investigating the Diagnostic Value of Procalcitonin in Patients with Acute Appendicitis
A Prospective Bicenter Study Investigating the Diagnostic Value of Procalcitonin in Patients with Acute Appendicitis
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DOI：
10.1159/000232939
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发表时间：
2009-01-01
影响因子：
1.6
通讯作者：
Mann, B.
中科院分区：
文献类型：
--
作者：
Sand, M.;Trullen, X. V.;Mann, B.
背景：降钙素原（PCT）是感染和脓毒症患者疾病严重程度的既定实验室标志物。此外，PCT已被证明是有限数量局部感染的有效标志物。然而，PCT是否对急性阑尾炎有任何诊断价值仍不清楚。因此，这项前瞻性双中心研究的目的是确定急性阑尾炎患者血清中PCT水平是否具有任何诊断价值。研究方法：这项前瞻性研究纳入了103名在德国的学术教学医院或西班牙的县医院的外科接受阑尾切除术的患者，这些患者基于急性阑尾炎的临床诊断。术前测定白色血细胞计数（WBC）、C反应蛋白（CRP）和降钙素原（PCT）值。所有阑尾切除标本均送去进行常规组织病理学评价。根据这些信息，患者被分配到反映阑尾炎严重程度的5组中的1组。结果：在纳入研究的103例患者中，98例患有阑尾炎。14例（14.3%）显示PCT值增加。在这14例中，4例血清PCT > 0.5ng/ml，9例PCT值>2-10 ng/ml，1例PCT值110 ng/ml。PCT的灵敏度计算为0.14。平均WBC值为13.0/nl（+/- 5.2，3.4-31），CRP为8.8 mg/dl（+/- 13，0-60.2）。CRP、WBC、PCT随阑尾炎程度加重而升高。结论：PCT在罕见的严重炎症病例中可能会增加，特别是在阑尾穿孔或坏疽性阑尾炎后。然而，由于其灵敏度极低，因此无法常规用于诊断阑尾炎。版权所有（C）2009 S. Karger AG，巴塞尔
Background: Procalcitonin (PCT) is an established laboratory marker for disease severity in patients with infection and sepsis. In addition, PCT has been shown to be an effective marker for a limited number of localized infections. However, whether or not PCT has any diagnostic value for acute appendicitis, still remains unclear. The purpose of this prospective bicenter study was, therefore, to determine whether or not the PCT levels in the serum of patients with acute appendicitis have any diagnostic value. Methods: This prospective study included 103 patients who received an appendectomy, based on the clinical diagnosis of acute appendicitis, in a surgical department of an academic teaching hospital in Germany or in a county hospital in Spain. White blood cell count (WBC), C-reactive protein (CRP) and procalcitonin (PCT) values were determined preoperatively. All appendectomy specimens were sent for routine histopathological evaluation. Based on this information, the patients were assigned to 1 of 5 groups that reflected the severity of the appendicitis. Results: Of the 103 patients who were included in the study, 98 had appendicitis. Fourteen (14.3%) showed an increase in PCT values. Of those 14, 4 had a serum PCT >0.5 ng/ml, 9 had a PCT value >2-10 ng/ml and 1 had a PCT value 1 10 ng/ml. The sensitivity of PCT was calculated to be 0.14. The mean WBC value was 13.0/nl (+/- 5.2, 3.4-31), and for CRP it was 8.8 mg/dl (+/- 13, 0-60.2). The values of CRP, WBC and PCT increased with the severity of the appendicitis. Conclusions: PCT is potentially increased in rare cases of severe inflammation and, in particular, after appendiceal perforation or gangrenous appendicitis. However, its remarkably low sensitivity prohibits its routine use for the diagnosis of appendicitis. Copyright (C) 2009 S. Karger AG, Basel