Procalcitonin as a predictor of severe appendicitis in children

Abstract

The aim of this study was to assess the diagnostic value of procalcitonin (PCT) in 212 children with appendicitis and compare it with that of the standard diagnostic modalities, C-reactive protein (CRP) level, leukocyte count, and abdominal ultrasound findings, in relation to the surgical and histological findings of the appendix. A PCT value of >0.5 ng/ml was found to be indicative of perforation or gangrene with 73.4% sensitivity and 94.6% specificity, a CRP level of >50 mg/l and a leukocyte count of >10(4)/mm3 were useful diagnostic markers for perforation, while abdominal ultrasonography had a sensitivity of 82.8% and a specificity of 91.2% for detecting appendicitis with imaging findings. PCT measurement seems to be a useful adjunctive tool for diagnosing acute necrotizing appendicitis or perforation, and surgical exploration will probably be required in patients with PCT values >0.5 ng/ml.

The prognostic value of Pro-Calcitonin, CRP and thyroid hormones in secondary peritonitis;A single-center prospective study

“…This showed the importance of procalcitonin and CRP as a prognostic marker in appendicitis. [18] In our study, the median preoperative serum PCT and CRP levels of patients with perforated appendicitis (n=21) were 9.9 ng/ml and 190 mg/L. These values regressed to 0.19 ng/ml and 63 mg/L respectively, for both parameters on postoperative day 14.…”

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

“…However, the fact that half of the cases with AA in the current study had a PCT level of <0.5 ng/mL may be in line with current theories. It is suggested that appendicitis either has a viral origin or that risk factors such as low-fiber diet cause stool retention in the appendix by slowing intestinal transit time, thus, not leading to an increase in PCT levels (22). On the other hand, in the surgery group, the PCT levels were significantly high in cases of perforated and necrotizing AA (7 of 16 cases).…”

“…Over the course of an inflammatory process, bacterial invasion of the appendix wall is followed by release of bacterial endotoxins (22). As the bacterial endotoxins are one of the most potent factors known to stimulate an increase in PCT concentration, PCT levels are expected to rise in AA.…”

“…These levels were seen to be not only higher than histologically normal appendix cases but also higher than noncomplicated AA cases. In a study by Kafetzis et al (22), PCT values above 0.5 ng/mL were considered a good prognostic factor for the development of complications, i.e., perforation or necrotic changes. Similar results for PCT were obtained in the current study in patients who developed complications during the course of AA.…”

Diagnostic value of procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for acute complicated appendicitis

“…Surgically eliminating inflammatory agents combined with effective antibiotics brings about a decrease in PCT levels [16]. Kafetzis et al [17] reported that PCT values>0.5 ng/mL are a good indication of the possible development of complications, perforation, or necrotic changes. In the present study, similar results were obtained in the PCT levels in patients with AA who developed complications, as well as in patients with complicated appendicitis.…”