C-Reactive Protein and Procalcitonin Are Predictors of the Severity of Acute Appendicitis in Children
Pediatric Emergency Care, 05/07/2012
Gavela T et al. – On admission, procalcitonin (PCT) and C–reactive protein (CRP) predict the outcome of pediatric patients with appendicitis. Children with CRP greater than 3mg/dL and/or PCT greater than 0.18ng/mL have a greater risk of complications; thus, intervention should be early, and patients should be monitored closely.
The authors 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).
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 4.95ng/mL [P<0.001] and 3 vs 14.3mg/dL [P<0.001]).
For a diagnosis of peritonitis, a PCT cutoff of 0.18ng/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 3mg/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.
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