Accurate diagnosis of acute abdomen in FMF and acute appendicitis patients: how can we use procalcitonin?

Abstract

This study was conducted to define the value of procalcitonin (PCT) levels in the differential diagnosis of abdominal familial Mediterranean fever (FMF) attacks from acute appendicitis. From October 2006 to January 2007, 28 FMF (12 males, 16 females) patients with acute abdominal attacks and 34 patients (18 males) with acute abdomen who underwent operation with the clinical diagnosis of acute appendicitis were consecutively enrolled in this study. FMF patients with concurrent infectious diseases were excluded. PCT values were measured by an immunofluorescent method using the B.R.A.H.M.S. PCT kit (B.R.A.H.M.S. Diagnostica, Berlin, Germany). Erythrocyte sedimentation rate (ESR), C-reactive proteins (CRP) and leucocyte levels were also noted. Mean disease duration in FMF patients was 9.6 +/- 8.1 years (range 2-33 years) and all were on colchicine therapy with a mean colchicine dosage of 1.2 +/- 0.4 mg/day. Among the operated patients, 5 were excluded: 3 patients had normal findings and 2 had intestinal perforation (PCT levels were 2.69 and 4.93 ng/ml, respectively) at operative and pathologic evaluation. There were no significant differences between the two groups with respect to gender and age (p was not significant (NS) for all). Acute phase reactants and PCT levels were increased in patients with FMF compared to patients with acute appendicitis (0.529[0.12 +/- 0.96] vs 0.095 [0.01-0.80] p < 0.001, respectively). PCT levels higher than 0.5 ng/ml were found in 11% (3/28) of FMF patients compared to 62% (18/29) of acute appendicitis patients (p < 0.001). Our results suggest that PCT could be a useful test in the differentiation of abdominal FMF attacks from acute appendicitis, though it should not supplant more conventional investigations.

Acute appendicitis in a 14-year-old boy with familial Mediterranean fever

“…PCT is also known as an inflammation marker, and has been advocated as a useful test for differentiating abdominal FMF attacks from acute appendicitis. This suggestion is based on the observations that PCT levels tend to remain <0.5 ng/ mL during FMF abdominal attacks, but are elevated during acute appendicitis [29]. In our case, although the preoperative PCT level (0.65 ng/mL) was consistent with previous findings, the PCT level was much higher (1.32 ng/mL) at the time of the patient's first admission for an FMF abdominal attack.…”

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

“…This is also reflected by the poor sensitivity of 0.14, which, from the authors' point of view, prohibits its usage as a potential diagnostic marker. As our first results contradicted those reported by Kisacik et al [14] , very early on in our study, we began analyzing the method of determining the levels of PCT and specimen collection to rule out systematic errors that may have led to lower PCT concentrations than those reported by other authors. In addition, since the PCT controls, who were all septic patients from the surgical ICU of our respective departments, were positive and evaluated identically, we concluded that the measurement of PCT was without error.…”

“…Acute appendicitis in adolescents or adults has rarely been subject of research regarding the diagnostic value of PCT. The only study available to date that investigated adult patients is by Kisacik et al [14] , who studied 34 adult patients with acute appendicitis and 28 with familial Mediterranean fever attacks. They report PCT levels that are higher than 0.5 ng/ml in 62% of their patients with acute appendicitis and in 11% of their patients with familial Mediterranean fever.…”

Familial Mediterranean fever gene mutations in the inner northern region of Turkey and genotype–phenotype correlation in children

“…Therefore, we suggest that the number of cases in this study was not large enough to allow the detection of differences in the frequency of attacks between these groups. FMF can cause severe abdominal pain that may lead to inappropriate surgical interventions 22,38 . We conclude that the homozygous genotype causes a predisposition to severe disease ( P < 0.01).…”