1st Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Athens, Greece.
Surgery. 2011 Mar;149(3):394-403. doi: 10.1016/j.surg.2010.08.007.
To our knowledge, the predictive value of procalcitonin for bowel strangulation has been evaluated in only 2 experimental studies that had conflicting results. The objective of this study was to evaluate the value of procalcitonin for early diagnosis of intestinal ischemia and necrosis in acute bowel obstruction.
We performed a prospective study of 242 patients with small- or large-bowel obstructions in 2005. A total of 100 patients who underwent operation were divided into groups according to the presence of ischemia (reversible and irreversible) and necrosis, respectively, as follows: ischemia (n = 35) and nonischemia groups (n = 65) and necrosis (n = 22) and nonnecrosis groups (n = 78). Data analyzed included age, sex, vital signs, symptoms, clinical findings, white blood cell count, base deficit, metabolic acidosis, procalcitonin levels on presentation, the time between symptom onset and arrival at the emergency department and the time between arrival and operation, and the cause of the obstruction.
Procalcitonin levels were greater in the ischemia than the nonischemia group (9.62 vs 0.30 ng/mL; P = .0001) and in the necrosis than the non-necrosis group (14.53 vs 0.32 ng/mL; P = .0001). Multivariate analysis identified procalcitonin as an independent predictor of ischemia (P = .009; odds ratio, 2.252; 95% confidence interval, 1.225-4.140) and necrosis (P = .005; odds ratio, 2.762; 95% confidence interval, 1.356-5.627). Using receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) of procalcitonin for ischemia and necrosis was 0.77 and 0.87, respectively. A high negative predictive value for ischemia and necrosis of procalcitonin levels <0.25 ng/mL (83% and 95%, respectively) and a positive predictive value of procalcitonin >1 ng/mL were identified (95% and 90%, respectively).
Procalcitonin on presentation is very useful for the diagnosis or exclusion of intestinal ischemia and necrosis in acute bowel obstruction and could serve as an additional diagnostic tool to improve clinical decision-making.
据我们所知，降钙素原对绞窄性肠梗寨的预测价值仅在两项实验研究中进行了评估，这两项研究的结果存在冲突。本研究的目的是评估降钙素原对急性肠梗阻并发肠缺血和坏死的早期诊断价值。
我们在 2005 年对 242 例小肠或大肠梗阻患者进行了前瞻性研究。共有 100 例接受手术的患者根据是否存在缺血（可逆性和不可逆性）和坏死分为以下两组：缺血组（n=35）和非缺血组（n=65）以及坏死组（n=22）和非坏死组（n=78）。分析的数据包括年龄、性别、生命体征、症状、临床发现、白细胞计数、基础缺失、代谢性酸中毒、就诊时降钙素原水平、症状发作至急诊科就诊的时间以及就诊至手术的时间以及梗阻的原因。
缺血组的降钙素原水平高于非缺血组（9.62 与 0.30ng/ml；P=0.0001），坏死组的降钙素原水平高于非坏死组（14.53 与 0.32ng/ml；P=0.0001）。多变量分析确定降钙素原是缺血（P=0.009；比值比，2.252；95%置信区间，1.225-4.140）和坏死（P=0.005；比值比，2.762；95%置信区间，1.356-5.627）的独立预测因子。使用受试者工作特征（ROC）曲线分析，降钙素原对缺血和坏死的曲线下面积（AUC）分别为 0.77 和 0.87。降钙素原水平<0.25ng/ml 对缺血和坏死的阴性预测值较高（分别为 83%和 95%），降钙素原>1ng/ml 的阳性预测值较高（分别为 95%和 90%）。
就诊时降钙素原对急性肠梗阻并发肠缺血和坏死的诊断或排除非常有用，可作为辅助诊断工具，以改善临床决策。
