Pouraghaei Mahboub, Shahsavarinia Kavous, Kakaei Farzad, Gholipour-Khalili Sevda, Mohammadpour Babak, Moharamzadeh Payman, Balafar Moloud
Emergency Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Department of Surgery and Transplantation, Tabriz University of Medical Sciences, Tabriz, Iran.
Arch Acad Emerg Med. 2019 Apr 6;7(1):e24. eCollection 2019.
Carcinogen antigen 125 (CA-125) is a glycoprotein antigen, which has shown potentials in predicting peritoneal inflammation. The aim of this study is to determine the value of CA-125 in predicting acute appendicitis (AA).
This prospective diagnostic accuracy study was conducted on 15 - 70 year-old patients with acute abdominal pain, suspected to AA, referred to emergency department. The serum level of CA-125 was measured for all patients before appendectomy and its screening characteristics in detection of AA case (confirmed by histology findings) were calculated and reported with 95% confidence interval (CI).
95 patients with the mean age of 31.65 ± 12.9 (15-75) years were studied (54.3% male). Based on the histologic findings, 72 (75.8%) cases were categorized as AA (23 cases as severe). AA and non-AA (NAA) groups were similar regarding the mean age (p = 0.59), mean duration of symptoms (p = 0.08), mean white blood cell (WBC) count (p = 0.37), and mean PMN percentage (p = 0.55). Mean CA-125 level was 16.5 ± 20.0 U/mL in the AA group and 30.5 ± 6.1 U/mL in the NAA group (p = 0.001). Adjustment of analysis based on gender revealed a significant correlation between CA-125 level and diagnosis of AA only in females (34.23 ± 39 U/mL in NAA versus 20.7 ± 26.7 U/mL in AA, p = 0.012). The area under the ROC curve of CA-125 was 0.62 (95%CI: 0.51 to 0.72). Sensitivity, specificity, NPV, PPV, NLR, and PLR of CA-125 in 16.4 U/mL cut off (best point) were 77.8% (95%CI: 66.4 - 86.7), 50.0% (95%CI: 28.2 - 71.8), 83.6% (95%CI: 76.7 - 88.7), and 40.7% (95%CI: 27.4 - 55.6), 0.44 (95%CI 0.2 - 0.8), and 1.56 (95%CI: 1.0 - 2.4), respectively.
Considering the lower levels of CA-125 in patients with AA compared with NAA cases and also weak screening performance characteristics, it seems that it could not be considered as an accurate screening tool in this regard.
癌抗原125（CA - 125）是一种糖蛋白抗原，在预测腹膜炎症方面显示出潜力。本研究的目的是确定CA - 125在预测急性阑尾炎（AA）中的价值。
这项前瞻性诊断准确性研究针对15至70岁因急性腹痛疑似患AA而转诊至急诊科的患者进行。在阑尾切除术前对所有患者测量血清CA - 125水平，并计算其在检测AA病例（经组织学检查确诊）中的筛查特征，并以95%置信区间（CI）报告。
研究了95例平均年龄为31.65±12.9（15 - 75）岁的患者（54.3%为男性）。根据组织学检查结果，72例（75.8%）病例被归类为AA（23例为重度）。AA组和非AA（NAA）组在平均年龄（p = 0.59）、平均症状持续时间（p = 0.08）、平均白细胞（WBC）计数（p = 0.37）和平均中性粒细胞百分比（p = 0.55）方面相似。AA组的平均CA - 125水平为16.5±20.0 U/mL，NAA组为30.5±6.1 U/mL（p = 0.001）。基于性别的分析调整显示，仅在女性中CA - 125水平与AA诊断之间存在显著相关性（NAA组为34.23±39 U/mL，AA组为20.7±26.7 U/mL，p = 0.012）。CA - 125的ROC曲线下面积为0.62（95%CI：0.51至0.72）。CA - 125在截断值为16.4 U/mL（最佳点）时的敏感性、特异性、阴性预测值、阳性预测值、阴性似然比和阳性似然比分别为77.8%（95%CI：66.4 - 86.7）、50.0%（95%CI：28.2 - 71.8）、83.6%（95%CI：76.7 - 88.7）、40.7%（95%CI：27.4 - 55.6）、0.44（95%CI 0.2 - 0.8）和1.56（95%CI：1.0 - 2.4）。
考虑到AA患者的CA - 125水平低于NAA病例，且筛查性能特征较弱，在这方面似乎不能将其视为一种准确的筛查工具。
