Yuzbasioglu Yucel, Duymaz Hikmet, Tanrikulu Ceren Sen, Halhalli Huseyin Cahit, Koc Mirac Ozturk, Tandoğan Meral, Coskun Figen
Departmentof Emergency Medicine, Ankara Atatürk Training and Research Hospital, Ankara, Turkey.
Department of Emergency Medicine, Ankara Training and Research Hospital, Ankara, Turkey.
Eurasian J Med. 2016 Oct;48(3):162-166. doi: 10.5152/eurasianmedj.2016.0052.
The aim of this study is to investigate the relationship between procalcitonin (PCT) level and the severity of acute cholecystitis.
This study included 200 patients diagnosed with acute cholecystitis. To diagnose and assess the severity of acute cholecystitis; physical examination and abdominal ultrasound findings were evaluated and blood samples were taken to determine white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and levels of coagulation factors, blood gas, C-reactive protein (CRP) and PCT. Patients were classified into three stages, namely, mild, moderate, and severe, according to the severity of acute cholecystitis using the Tokyo guidelines. The role of PCT level in the assessment of severity of acute cholecystitis and the correlation between the stages and PCT level were statistically analyzed.
Among patients with acute cholecystitis, 110 (55%) were classified as mild, 61 (30.5%) as moderate, and 29 (14.5%) as severe. Leukocytosis or leukopenia was positive in 48.5%, ESR elevation was found in 72.5%, CRP positivity in 55.5%, PCT elevation in 27%, and positive findings of ultrasonographic imaging in 54.5% of the patients. Serum WBC count, ESR, and CRP and PCT levels increased as the severity of disease increased (p<0.05). PCT could discriminate grade I from grade II-III with 95.45% sensitivity and 46.67% specificity at the best cut-off value of ≤0.52 (p<0.001). PCT could also discriminate grade III from grade I-II with 72.4% sensitivity and 90.06% specificity at the best cut-off value of >0.8 (p<0.001).
PCT level may be considered to be a parameter that could be added to the assessment of the severity of acute cholecystitis in the Tokyo guidelines, although further studies are needed to support our findings.
本研究旨在探讨降钙素原（PCT）水平与急性胆囊炎严重程度之间的关系。
本研究纳入200例诊断为急性胆囊炎的患者。为诊断和评估急性胆囊炎的严重程度，对体格检查和腹部超声检查结果进行评估，并采集血样以测定白细胞（WBC）计数、红细胞沉降率（ESR）、凝血因子水平、血气、C反应蛋白（CRP）和PCT。根据东京指南，按照急性胆囊炎的严重程度将患者分为轻度、中度和重度三个阶段。对PCT水平在评估急性胆囊炎严重程度中的作用以及各阶段与PCT水平之间的相关性进行统计学分析。
在急性胆囊炎患者中，110例（55%）为轻度，61例（30.5%）为中度，29例（14.5%）为重度。48.5%的患者白细胞增多或减少呈阳性，72.5%的患者ESR升高，55.5%的患者CRP呈阳性，27%的患者PCT升高，54.5%的患者超声成像有阳性发现。随着疾病严重程度的增加，血清WBC计数、ESR、CRP和PCT水平升高（p<0.05）。在最佳截断值≤0.52时，PCT区分I级与II - III级的灵敏度为95.45%，特异度为46.67%（p<0.001）。在最佳截断值>0.8时，PCT区分III级与I - II级的灵敏度为72.4%，特异度为90.06%（p<0.001）。
尽管需要进一步研究来支持我们的发现，但PCT水平可被视为一个可添加到东京指南中评估急性胆囊炎严重程度的参数。
