Diagnostic Value of Procalcitonin Levels Compared to Leukocyte and CRP Levels in Detecting Acute Perforated Appendicitis in Children at Saiful Anwar Hospital Malang
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2018, Vol 17, Issue 12
Abstract
Appendicitis is an acute abdominal case in children often found in surgical clinical practice. Specific and accurate diagnostic methods for predicting acute and perforated appendicitis in children have not been established and is a challenge. Examinations such as CT scans have disadvantages such as radiation risk and unavailability of these facilities in several health service centers, while Ultrasound is not realiable since it is operator dependent and 46% of cases of appendix cannot be evaluated due to individual variations. The most commonly used diagnostic parameters are leukocyte examination, CRP and Procalcitonin as the recently used parameter, where the levels are detected in acute appendicitis and have an increase in perforated cases. Therefore, this study examined the significance of leukocytes, CRP and Procalcitonin in predicting the incidence of acute and perforated appendicitis. The purpose of the study was to determine the specificity, sensitivity, cut-off of leukocyte levels, CRP and procalcitonin in predicting acute perforated appendicitis. The research method used observational cohort study conducted to children aged 2-18 years with lower right abdominal pain and suspected appendicitis at Syaiful Anwar Hospital Malang for 1 year. The examinations of leukocytes, CRP, and Procalcitonin were carried out before surgery. Data analysis was performed using the Mann Whitney Uand Chi Square tests. For the cut-off evaluation, the homogeneous data were entered into the ROC curve to obtain sensitivity, cut-off specificity of leukocytes, CRP and Procalcitonin evaluations. From June, 2016 to June 2017, it was obtained 45 patients consisting of 10 acute appendicitis and 35 perforated appendicitis patients who met the inclusion criteria. Based on gender distribution, it was obtained 16 female patients and 29 male patients. Gender differences did not differ significantly in perforated incidents. Based on the distribution test for leukocytes, CRP and Procalcitonin, It showed that there was no significant results. It was obtained accuracy of 68.6% for leukocytes with a sensitivity of 68.6%, specificity of 70% and cut off value of 14,930. CRP had an accuracy of 95.1% with a cut off value of 6,375,while Procalcitonin had the accuracy of 97.7% with a cut off value of 0.35. The sensitivity and specificity for CRP and procalcitonin have the same values of 91.4% and 90%, respectively. It can be concluded that procalcitonin was not a significant parameter in predicting the incidence of perforated appendicitis. The results indicated that thesensitivity and specificity of leukocyte were the lowest, while the sensitivity and specificity of CRP and procalcitonin were similar, but the accuracy of procalcitonin was better compared to CRP and leukocytes. The cut off value was obtained from a wide range of data, so that it was difficult to use itin making clinical decisions. More sample data are needed to be applied clinically. Further studies need to consider the use of other more potent proinflammatory biomarkers other than procalcitonin, leukocytes and CRP to evaluate the incidence of acute and perforated appendicitis in pediatric surgical patients.
Authors and Affiliations
Erika Kusuma Santoso, Lulik Inggarwati
Keywords
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- DOI 10.9790/0853-1712074046.
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