Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.
World J Surg. 2012 Aug;36(8):1744-9. doi: 10.1007/s00268-012-1579-z.
The aim of this study was to assess the diagnostic value of procalcitonin (PCT) in emergency department (ED) patients with suspected appendicitis.
A prospective observational study was carried out in the emergency department of a university hospital between July 2007 and June 2008. Adult patients who presented to the ED with clinically suspected appendicitis were enrolled. Each patient underwent serum PCT, C-reactive protein (CRP), and Alvarado score evaluation on admission. The results of these three measurements were analyzed in relation to the final diagnosis determined by histopathological findings or compatible computed tomography findings.
Of the 214 study patients, 113 (52.8 %) had a confirmed diagnosis of appendicitis and 58 had complicated appendicitis (phlegmon, perforation, or gangrene). For the diagnosis of appendicitis, the area under the receiving operating characteristic (ROC) curve is 0.74 for Alvarado score, 0.69 for PCT, and 0.61 for CRP. Overall, the Alvarado score has the best discriminative capability among the three tested markers. We adopted two cutoff point approaches to harness both ends of the diagnostic value of a biomarker. PCT levels were significantly higher in patients with complicated appendicitis. For diagnosis of complicated appendicitis, a cutoff value of 0.5 ng/mL had a sensitivity of 29 % and a specificity of 95 %, while a cutoff value of 0.05 ng/ml had a sensitivity of 85 % and a specificity of 30 % in diagnosing complicated appendicitis. For those with a PCT value in the gray zone, clinical findings may play a more important role.
The study does not support the hypothesis that the PCT test may be useful for screening ED patients for appendicitis. However, determination of the PCT level may be useful for risk assessment of ED patients with suspected complicated appendicitis.
本研究旨在评估降钙素原（PCT）在急诊科疑似阑尾炎患者中的诊断价值。
这是一项于 2007 年 7 月至 2008 年 6 月在一所大学医院急诊科进行的前瞻性观察性研究。纳入以疑似阑尾炎就诊于急诊科的成年患者。每位患者入院时均进行血清 PCT、C 反应蛋白（CRP）和 Alvarado 评分评估。分析这三种测量方法的结果与组织病理学或相容 CT 发现确定的最终诊断之间的关系。
在 214 例研究患者中，113 例（52.8%）确诊为阑尾炎，58 例为复杂阑尾炎（蜂窝织炎、穿孔或坏疽）。对于阑尾炎的诊断，Alvarado 评分的接收者操作特征（ROC）曲线下面积为 0.74，PCT 为 0.69，CRP 为 0.61。总体而言，Alvarado 评分在三种测试标志物中具有最佳的鉴别能力。我们采用了两种截断值方法来利用生物标志物诊断价值的两个极端。复杂阑尾炎患者的 PCT 水平显著升高。对于复杂阑尾炎的诊断，截断值为 0.5ng/ml 时的敏感性为 29%，特异性为 95%，截断值为 0.05ng/ml 时的敏感性为 85%，特异性为 30%。对于 PCT 值处于灰色地带的患者，临床发现可能发挥更重要的作用。
本研究不支持 PCT 检测可能有助于筛选急诊科阑尾炎患者的假设。然而，确定 PCT 水平可能有助于评估疑似复杂阑尾炎的急诊科患者的风险。
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