Role of Procalcitonin in the Timely Detection of Ischemia and Necrosis in Children With Intestinal Obstruction

Abstract

Introduction: Procalcitonin (PCT) has been studied for early identification of ischemia and/or necrosis (I/N) in children with intestinal obstruction (IO) secondary to adhesive small bowel obstruction (ASBO). However, the causes of IO in children are numerous. Purpose: To correlate the level of PCT with the presence of I/N.Results: Fifty-seven patients were analyzed. The incidence of I/N was 36%. PCT median was statistically higher in patients with I/N compared to those patients with normal intestine: 4.13 (13.9) vs 0.11 (0.28) ng/ml, p = <0.001. A PCT threshold >1.17 ng/ml for predicting I/N yielded a sensitivity of 90%, a specificity of 97%, a positive predictive value (PPV) of 95%, a negative predictive value (NPV) of 94%, p = <0.001, relative risk (RR) 17.57 (95%CI, 4.54 – 67.90). Similarly, a PCT threshold >1.41 ng/ml for predicting intestinal necrosis yielded a sensitivity of 92%, a specificity of 88%, a PPV of 72%, a NPV of 97%, p = <0.001, RR 28.16 (95%CI, 3.98 – 119.12).Conclusions: This study corroborates the association of PCT with IN in children with IO and expands the evidence of its use in this field. Similarly, suggests a PCT threshold >1.17 ng/ml and >1.41 for predicting IN and intestinal necrosis respectively.