C-Reactive Protein and Procalcitonin Are Predictors of the Severity of Acute Appendicitis in Children

降钙素原 医学 腹膜炎 重症监护室 C反应蛋白 内科学 阑尾炎 儿科重症监护室 胃肠病学 急性阑尾炎 败血症 重症监护 预测值 试验预测值 脓肿 外科 儿科 重症监护医学 炎症
作者
Teresa Gavela,Beatriz Cabeza,Ana Serrano,Juan Casado‐Flores
出处
期刊:Pediatric emergency care [Lippincott Williams & Wilkins]
卷期号:28 (5): 416-419 被引量:42
标识
DOI:10.1097/pec.0b013e318252d875
摘要

Objective The aim of this study was to evaluate the use of procalcitonin (PCT) and C-reactive protein (CRP) on admission as predictors of the severity of appendicitis in children. Methods We prospectively studied 111 consecutive patients admitted with a diagnosis of acute appendicitis between July 2009 and February 2010 and recorded the following variables: age, sex, time since diagnosis, laboratory data, complications (abscess, intestinal obstruction), presence of hemodynamic instability, mortality, length of stay, and need for admission to the pediatric intensive care unit. Patients were divided into 2 groups according to the diagnosis confirmed during surgery (group 1, appendicitis; group 2, localized or generalized peritonitis). Results Group 1 comprised 69 patients, and group 2 comprised 42 patients. Procalcitonin and CRP values were significantly lower in group 1 than in group 2 (0.15 vs 4.95 ng/mL [P < 0.001] and 3 vs 14.3 mg/dL [P < 0.001]). For a diagnosis of peritonitis, a PCT cutoff of 0.18 ng/mL gave a sensitivity of 97%, specificity of 80%, positive predictive value of 72%, and negative predictive value of 89.3%. The equivalent values for a CRP cutoff of 3 mg/dL were 95%, 74%, 68%, and 96.2%. Complications and the need for admission to the pediatric intensive care unit were more common in patients with peritonitis. Conclusions On admission, CRP and PCT predict the outcome of pediatric patients with appendicitis. Children with CRP greater than 3 mg/dL and/or PCT greater than 0.18 ng/mL have a greater risk of complications; thus, intervention should be early, and patients should be monitored closely.
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