Department of Emergency Medicine, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui city, Fukui 910-8526, Japan.
Department of Emergency Medicine, Japanese Red Cross Fukui Hospital, 2-4-1, Tsukimi, Fukui city, Fukui 918-8501, Japan.
Am J Emerg Med. 2020 May;38(5):979-982. doi: 10.1016/j.ajem.2020.02.022. Epub 2020 Feb 19.
The early identification of patients with small bowel obstruction who require surgical treatment could potentially lead to improved patient outcomes. We evaluated the efficacy of point-of-care procalcitonin for predicting surgical treatment among patients with small bowel obstruction.
This was a prospective observational study. We measured serum procalcitonin levels in patients who presented to the emergency department and were diagnosed with small bowel obstruction from April 1, 2018 through March 31, 2019. Patients were grouped into two groups: the elevated procalcitonin and normal procalcitonin groups. Our primary outcome was surgical treatment.
A total of 53 patients with small bowel obstruction were included in the study, and 11 patients (20.8%) were treated operatively. Baseline characteristics were similar, except for age, between the elevated procalcitonin (≥0.12 ng/ml) and normal procalcitonin groups. The elevated procalcitonin level was significantly correlated with surgical treatment and hospital length of stay (p < 0.05). The sensitivity, specificity, and positive likelihood of procalcitonin for the former were 45.5%, 85.7%, and 5.0 respectively.
The patients with small bowel obstruction who had elevated procalcitonin levels on presentation showed significantly higher rate of surgical treatment than those who had normal procalcitonin levels. Point-of-care procalcitonin might predict the need for surgical treatment in patients with small bowel obstruction and could be used as an additional diagnostic test. Further studies with more patients are needed to investigate the predictive value of point-of-care procalcitonin for surgical treatment.
早期识别需要手术治疗的小肠梗阻患者可能会改善患者的预后。我们评估了即时检测降钙素原在预测小肠梗阻患者手术治疗中的作用。
这是一项前瞻性观察性研究。我们在 2018 年 4 月 1 日至 2019 年 3 月 31 日期间，测量了急诊科就诊并诊断为小肠梗阻的患者的血清降钙素原水平。患者被分为两组：降钙素原升高组和降钙素原正常组。我们的主要结局是手术治疗。
共有 53 例小肠梗阻患者纳入研究，11 例（20.8%）患者接受了手术治疗。除年龄外，两组患者的基线特征相似。降钙素原升高组（≥0.12ng/ml）与降钙素原正常组相比，手术治疗和住院时间明显延长（p<0.05）。降钙素原的敏感性、特异性和阳性似然比分别为 45.5%、85.7%和 5.0。
就诊时降钙素原升高的小肠梗阻患者的手术治疗率明显高于降钙素原正常的患者。即时检测降钙素原可能有助于预测小肠梗阻患者是否需要手术治疗，并可作为一种附加的诊断试验。需要更多的患者研究来进一步探讨即时检测降钙素原对手术治疗的预测价值。
