Journal of Isfahan Medical School

Journal of Isfahan Medical School

Is Procalcitonin a Reliable Prognostic Value in the Complicated Appendicitis? A Prospective Study and Literature Review

Document Type : Original Article(s)

Authors
Alireza Rezapanah 1
Javad Koushki 1
Narges Lamsehchi 2
Amin Dalili 3
Maryam Sarkardeh 4
1 Surgical Oncology Research Center, Faculty of Medicine, AND, Department of General Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
2 Department of General Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
3 Surgical Oncology Research Center, Faculty of Medicine, AND Department of General Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
4 Surgical Oncology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, AND Department of General Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, AND Breast Diseases Research center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
10.48305/jims.v44.i866.0956
Abstract
Background: Regarding the importance of early diagnosis of acute appendicitis and preventing mortality and morbidity due to late diagnosis of this disease, the study aims to evaluate the diagnostic effect of procalcitonin as a biomarker for complicated appendicitis.
Methods: This prospective and cross-sectional study was conducted on patients referred to Imam Reza Hospital in Mashhad from 2020-2021 with a clinical diagnosis of acute appendicitis. To obtain the necessary information for this study, all the information was collected based on the existing questionnaire and was analyzed by SPSS software version 25.
Findings: a total of 123 patients (64 males and 59 females) with an average age of 31.45 ± 10.60 years were included in the study. The most common signs and symptoms of patients were right lower quadrant (RLQ) tenderness and pain migration to RLQ, which were present in 122 patients (99.2%) and 116 patients (94.3%), respectively. Increased C-reactive protein (CRP) was observed in all patients, but increased procalcitonin and neutrophilia were present in 33.9% and 54.5% of patients, respectively. in procalcitonin, the sensitivity and specificity for distinguishing complicated from uncomplicated appendicitis were equal to 100% and 92.7%, in CRP were equal to 100% and 0%, in ultrasound were equal to 100% and 73.3% and finally in Alvarado score were equal to 86.7% and 16%.
Conclusion: Although Procalcitonin does not have high sensitivity in diagnosing acute appendicitis, it may have specificity to recognize complicated appendicitis.

Highlights

Alireza Rezapanah: Google Scholar ,PubMed

Maryam Sarkardeh: Google Scholar ,PubMed

Keywords
Appendicitis
Procalcitonin
Perforated Appendicitis
Phlegmon
Subjects
1.     Donald N, Halliday L, Smith G, Dighe S. Risk factors associated with negative appendicectomy rates: A retrospective cohort study. Cureus 2024; 16(7): e64509.
2.     Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg 2020; 15(1): 27.
3.     Piri SM, Moghaddam SS, Ghodsi Z, Yoosefi M, Rezaei N, Saadat S, et al. Trend of appendicitis mortality at national and provincial levels in Iran from 1990 to 2015. Arch Iran Med 2020; 23(5): 302–11.
4.     Sellars H, Boorman P. Acute appendicitis. Surgery (Oxford). Elsevier; 2017; 35(8): 432–8.
5.     van Rossem CC, Bolmers MDM, Schreinemacher MHF, Bemelman WA, van Geloven AAW, Pinkney TD, et al. Diagnosing acute appendicitis: surgery or imaging? Colorectal Dis. Colorectal Dis 2016; 18(12): 1129–32.
6.     Scheijmans JCG, Haijanen J, Flum DR, Bom WJ, Davidson GH, Vons C, et al. Antibiotic treatment versus appendicectomy for acute appendicitis in adults: an individual patient data meta-analysis. Lancet Gastroenterol Hepatol 2025; 10(3): 222–33.
7.     Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet 2015; 386(10000): 1278–87.
8.     Ashdown HF, D’Souza N, Karim D, Stevens RJ, Huang A, Harnden A. Pain over speed bumps in diagnosis of acute appendicitis: diagnostic accuracy study. BMJ 2012; 345: e8012.
9.     Acute appendicitis in adults: Clinical manifestations and differential diagnosis [cited 2024 Sep 30]. Available from: https://medilib.ir/uptodate/show/1386 [in Persian]
10.  Charles Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Kao LS, Hunter JG, et al. Schwartz’s Principles of Surgery, 11e. [cited 2024 Sep 30]. Available from: https://accessmedicine.mhmedical.com/book.aspx?bookID=2576
11.  Dale L. The use of procalcitonin in the diagnosis of acute appendicitis: a systematic review. Cureus 2022; 14(10): e30292.
12.  Dal F, Çiçek Y, Pekmezci S, Kocazeybek B, Tokman HB, Konukoğlu D, et al. Role of Alvarado score and biological indicators of C-reactive protein, procalicitonin and neopterin in diagnosis of acute appendicitis. Ulus Travma Acil Cerrahi Derg 2019; 25(3): 229–37.
13.  Li Y, Zhang Z, Cheang I, Li X. Procalcitonin as an excellent differential marker between uncomplicated and complicated acute appendicitis in adult patients. Eur J Trauma Emerg Surg 2020; 46(4): 853–8.
14.  Cui W, Liu H, Ni H, Qin X, Zhu L. Diagnostic accuracy of procalcitonin for overall and complicated acute appendicitis in children: a meta-analysis. Ital J Pediatr 2019; 45(1): 78.
15.  Tanrikulu CŞ, Karamercan MA, Tanrikulu Y, Öztürk M, Yüzbaşioǧlu Y, Coşkun F. The predictive value of Alvarado score, inflammatory parameters and ultrasound imaging in the diagnosis of acute appendicitis. Ulus Cerrahi Derg 2016; 32(2): 115-21.
16.  Duque GA, Oladipo AF, Lotfollahzadeh S. Appendicitis in Pregnancy. Treasure Island (FL): StatPearls Publishing; 2026.
17.  Prabhu M, Wilkie G, MacEachern M, LaBuda D, Purtell J, Rao K, et al. Procalcitonin levels in pregnancy: A systematic review and meta-analysis of observational studies. Int J Gynaecol Obstet 2023; 163(2): 484–94.
 
Journal of Isfahan Medical School
Volume 44, Issue 866
2nd Week, August
July and August 2026
Pages 956-962

  • Receive Date 20 October 2024
  • Accept Date 27 June 2026