Evaluation ofprocalcitonin as a biomarker ofdiagnosis,severity andpostoperative complications in adultpatients withacuteap- pendicitis

Background:Delay in diagnosis and treatment of acute appendicitis (AA) results in an increased rate of pe rforation, postoperative morbidity, mortality and hospital length of stay. Several biochemical parameters inclu ding white blood cell (WBC) count, C -reactive prot ein (CRP), interleukin -6 (IL6) and Procalcitonin (PCT) have been used to further improve the clinical diagnosis of AA. The aim of this study was to assess the value of pr ocalcitonin as a predictor of diagnosis and severity of appendicitis in order to impro ve the clinical decision ma king, sinceother studies have been unable to demonstrate a diagnostic value for PCT elevation in acute append icitis. Methods:One-hundred patients who underwent open appendectomy, including 75 men and 25 women with a mean ageof 28 years were included in this study. Procalcitonin values were measured by an immunofluore scent method). Serum PCT>0.5 ng/ml was considered positive. The PCT serum values were measured in four different categories, including �¬0.5ng/ml, 0.5 -2 ng/ml, 2 -10ng/ml and more than 10ng/ml. Results:The sensitivity and specificity of PCT level measurement for acute appendicitis diagnosis were 44% and 100% respectively. The value of PCT increased with the severity of appendicitis and also with the presence of peritonitis and infection, at the site of surgery. Conclusions:Procalcitonin measurement cannot be used as a diagnostic test for adult patients with acute a ppendicitis and its routine use in such patients is not cost effective and conclusive. Procalcitonin values can be used as a prognostic mar ker and predictor of infectious complications following surgery and it can help to carry out timely surgical intervention which is highly recommended in patients with PCT values more than 0.5ng/ml.