A Prospective Bicenter Study Investigating the Diagnostic Value of Procalcitonin in Patients with Acute Appendicitis

Abstract

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 >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.

The clinical value of leucocyte count and neutrophil percentage in diagnosing uncomplicated (simple) appendicitis and predicting complicated appendicitis

“…Several diagnostic tests are used for appendicitis including leucocyte count, neutrophil percentage, C-reactive protein (CRP), D-Dimer, and Procalcitonin. [3][4][5][6] However, today, there is no single laboratory test or imaging modality for diagnosing acute appendicitis with 100% sensitivity.…”

Diagnostic Role of Procalcitonin in Patients with Suspected Appendicitis

“…Relatively few studies have investigated the ability of PCT to diagnose localized infection. To the best of our knowledge, there are only five previous studies that addressed the role of PCT in diagnosing appendicitis, three of which investigated the pediatric population and two investigated the adult population [11,[22][23][24][25]. Kafetzis et al [23] found that PCT elevation greater than 0.5 ng/mL had a sensitivity of 73 % and a specificity of 92.3 % in identifying perforated appendicitis in pediatric patients.…”

The predictive value of Alvarado score, inflammatory parameters and ultrasound imaging in the diagnosis of acute appendicitis

“…The most commonly used tests are white blood cell count and serum C-reactive protein (CRP) levels. Erythrocyte sedimentation rate (ESR) serves as an indicator of inflammation and procalcitonin (PCT) levels have also been used recently (6)(7)(8).…”

“…The diagnostic value of PCT in AA in adolescents or adults has rarely been studied (6). Over the course of an inflammatory process, bacterial invasion of the appendix wall is followed by release of bacterial endotoxins (22).…”