Evaluation of procalcitonin versus conventional inflammatory biomarkers for clinical severity grading in patients with intra-abdominal infection

TL;DR

The study compares procalcitonin with traditional biomarkers in assessing the severity of abdominal infections, finding limited added value for clinical decisions.

Contribution

This study evaluates procalcitonin's effectiveness in severity grading of intra-abdominal infections compared to conventional biomarkers.

Findings

Median procalcitonin levels were significantly higher in calculous cholecystitis and pancreatitis compared to non-specific abdominal pain.

Procalcitonin correlates strongly with leukocyte count, neutrophil count, and C-reactive protein in intra-abdominal infection patients.

Procalcitonin offers limited additional clinical value for severity grading of intra-abdominal infections.

Abstract

We aimed to evaluate the utility of procalcitonin (PCT) as a biomarker for clinical severity grading of intra-abdominal infections (IAI) in hospital-admitted patients presenting with acute abdomen.

In this retrospective study, median PCT values were compared with conventional inflammatory biomarkers, including leukocyte count (LC), neutrophil count (NC), and C-reactive protein (CRP), within the patient population.

Among the 245 patients included in the study, 58 (23.7%) were diagnosed with appendicitis, 54 (22.0%) with diverticulitis, 34 (13.9%) with calculous cholecystitis, and 21 (8.6%) with pancreatitis. Additionally, 60 (24.5%) were diagnosed with non-specific abdominal pain (NSAP), and 18 (7.3%) with gallstones without cholecystitis. Median PCT levels were significantly higher in patients with calculous cholecystitis (p < 0.0001) and pancreatitis (p < 0.0001) compared to those with NSAP. The proportion of patients with a PCT cut-off ≥ 0.04 µg/L was significantly higher across all IAI subgroups compared to the NSAP group. However, 18 (10.8%) of IAI patients exhibited PCT levels ≥ 0.5 µg/L, indicating systemic infection. Spearman’s rho analysis revealed a significant correlation between PCT and LC, NC, and CRP in patients with IAI (p < 0.0001). Moreover, median PCT levels were significantly higher in perforation/abscess vs. gangrenous appendicitis (p < 0.01), complicated vs. uncomplicated diverticulitis (p = 0.048), and severe vs. mild cholecystitis (p < 0.001).

PCT correlates strongly with conventional inflammatory biomarkers in patients with IAI. However, PCT appears to offer limited additional clinical value for guiding therapeutic decisions concerning the initial diagnosis and/or severity grading of IAI in patients admitted with acute abdomen. Further research is warranted to validate these findings.

Figures