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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