Procalcitonin as an excellent differential marker between uncomplicated and complicated acute appendicitis in adult patients

Li, Yanxiu; Zhang, Zhongwen; Cheang, Iokfai; Li, Xinli

doi:10.1007/s00068-019-01116-2

Cited by 15 publications

(9 citation statements)

References 32 publications

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“…However, in this study high WCC was associated with a lower recurrence risk, as was presence of fever although this result was not statistically signi cant. Histologically-proven complicated AA has been associated with high CRP and high procalcitonin levels independently [21]. A systematic review of biomarkers in AA found that procalcitonin and interleukin-6 levels were predictive for perforated appendix but procalcitonin lacked sensitivity and both were high in cost [22].…”

Section: Discussionmentioning

confidence: 99%

Identifying recurrence risk factors in CT-confirmed acute appendicitis in adults managed non-operatively during the COVID-19 pandemic

Richards

Pendower

Kotecha

et al. 2022

Preprint

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Background/ObjectiveAcute appendicitis is predominantly managed with appendectomy, but can be treated non-operatively, leading to recurrence risk. Non-operative management has been more common since the COVID-19 pandemic affected the feasibility of performing surgery. This case-control study analyzed non-operatively managed patients in order to identify clinical and radiological factors associated with recurrence risk. MethodsOver 12 months, 48 adults with CT-proven acute appendicitis managed non-operatively were identified, and followed up for at least 6 further months to assess them for recurrence (reattendance to hospital more than 14 days after discharge and after symptom resolution, requiring treatment for appendicitis). Clinical and CT data were collected and a Cox regression survival analysis was performed to produce hazards ratios. ResultsOf the 48 patients, 12 (25%) experienced a recurrence up until the end of the follow-up period, 8 of whom were then treated operatively. On the univariate analysis, greater recurrence risk was observed in patients with diabetes mellitus, higher pulse rate (on admission and maximum value during admission), lower white cell count and neutrophils and appendiceal wall thinning on CT. On the multivariate analysis, diabetes mellitus (hazards ratio=7.72, p=0.021) and higher pulse rate (hazards ratio=1.08, p=0.018) were associated with statistically significant greater recurrence risk. ConclusionsDiabetes mellitus and higher pulse rate on admission are associated with greater recurrence risk of acute appendicitis managed non-operatively. No CT findings were associated with greater risk. Clinicians should therefore consider diabetes mellitus and pulse rate when making decisions on appendicitis management, during the COVID-19 pandemic and beyond.

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Section: Discussionmentioning

confidence: 99%

Identifying recurrence risk factors in CT-confirmed acute appendicitis in adults managed non-operatively during the COVID-19 pandemic

Richards

Pendower

Kotecha

et al. 2022

Preprint

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“…However, in this study high WCC was associated with a lower recurrence risk, as was presence of fever although this result was not statistically significant. Histologically-proven complicated AA has been associated with high CRP and high procalcitonin levels independently [ 21 ]. A systematic review of biomarkers in AA found that procalcitonin and interleukin-6 levels were predictive for perforated appendix but procalcitonin lacked sensitivity and both were high in cost [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Identifying Recurrence Risk Factors in CT-Confirmed Acute Appendicitis in Adults Managed Non-operatively During the COVID-19 Pandemic

Richards¹,

Pendower²,

Kotecha³

et al. 2022

Cureus

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Background/Objective: Acute appendicitis (AA) is predominantly managed with appendectomy, but can be treated non-operatively, leading to a high risk of recurrence. Non-operative management has been more common since the COVID-19 pandemic affected the feasibility of performing surgery. This case-control study analyzed non-operatively managed patients in order to identify clinical and radiological factors associated with recurrence risk. Methods: Over 12 months, 48 adults with CT-proven AA managed non-operatively were identified, and followed up for at least six further months to assess them for recurrence (readmission to hospital more than 14 days after discharge and after symptom resolution, requiring treatment for appendicitis). Clinical and CT data were collected and a Cox regression survival analysis was performed to produce hazards ratios (HRs).Results: Of the 48 patients, 12 (25%) experienced a recurrence up until the end of the follow-up period, eight of whom were then treated operatively, and four treated non-operatively. On the univariate analysis, greater recurrence risk was observed in patients with diabetes mellitus, higher heart rate (on admission and maximum value during admission), lower white cell count and neutrophils and appendiceal wall thinning on CT. On the multivariate analysis, diabetes mellitus (HR=7.72, p=0.021) and higher heart rate (HR=1.08, p=0.018) were associated with statistically significant greater recurrence risk. Conclusions: Diabetes mellitus and higher heart rate on admission are associated with greater recurrence risk of AA managed non-operatively. No CT findings were associated with statistically significant greater risk. Clinicians should, therefore, consider DM and heart rate when making decisions on appendicitis management, especially during the COVID-19 pandemic but also beyond it.

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“…[ 17 18 ] However, PCT and CRP levels are also important in differentiating between uncomplicated acute appendicitis with complicated acute appendicitis. [ 19 ] Therefore, the precise differential of acute appendicitis is essential for avoiding unnecessary risks of anesthesia and surgical intervention, and also lower hospitalization costs. [ 19 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 19 ] Therefore, the precise differential of acute appendicitis is essential for avoiding unnecessary risks of anesthesia and surgical intervention, and also lower hospitalization costs. [ 19 ]…”

Section: Discussionmentioning

confidence: 99%

A study of C-reactive protein and D-dimer in patients of appendicitis

Kumar

Maurya

Kumar

et al. 2020

J Family Med Prim Care

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Background: Acute appendicitis is the most common abdominal surgical emergencies across the world. Objective: The aim of this study was to determine the value of C-reactive protein (CRP) and D-dimer as diagnostic markers of acute appendicitis. Study Design: It was a Prospective observational clinical study. Method: The present study was carried out in General Surgical Unit of University Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi from September 2015 to July 2017. All data including patient's demography, clinical examination, laboratory test results, and appendix histology were summarized. Receiver operating characteristic (ROC) curve of TLC, CRP, and D-dimer was analyzed. Results: Total 65 patients who presented with periumbilical pain or pain in right iliac fossa (RIF) were included in the study. The mean age of the patients was 31.18 ± 14.59 years (range: 15 to 65 years) with male : female ratio was 2.21:1. The most common symptom was pain in right iliac fossa (100%) followed by nausea/vomiting (69.2%). The mean leucocyte count, CRP, and D-dimer levels were significantly raised in appendicitis group as compared to negative appendicectomy group ( P = 0.025, P = 0.036, and P = 0.025, respectively). The receiver operating characteristic (ROC) curve for TLC was not helpful for differentiating between appendicitis and negative appendicitis ( P = 0.073). In addition, D-dimer was helpful for differentiating between appendicitis and negative appendicitis ( P = 0.002). However, CRP was also found to be helpful for differentiating between appendicitis and negative appendicitis ( P = 0.030). Conclusion: The diagnosis of appendicitis remains multifactorial and biochemical markers like CRP and D-dimer may help to guide the surgeon in the decision making.

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Procalcitonin as an excellent differential marker between uncomplicated and complicated acute appendicitis in adult patients

Cited by 15 publications

References 32 publications

Identifying recurrence risk factors in CT-confirmed acute appendicitis in adults managed non-operatively during the COVID-19 pandemic

Identifying recurrence risk factors in CT-confirmed acute appendicitis in adults managed non-operatively during the COVID-19 pandemic

Identifying Recurrence Risk Factors in CT-Confirmed Acute Appendicitis in Adults Managed Non-operatively During the COVID-19 Pandemic

A study of C-reactive protein and D-dimer in patients of appendicitis

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