Elsevier

Surgery

Volume 149, Issue 3, March 2011, Pages 394-403
Surgery

Original Communication
Predictive value of procalcitonin for bowel ischemia and necrosis in bowel obstruction

https://doi.org/10.1016/j.surg.2010.08.007Get rights and content

Background

To our knowledge, the predictive value of procalcitonin for bowel strangulation has been evaluated in only 2 experimental studies that had conflicting results. The objective of this study was to evaluate the value of procalcitonin for early diagnosis of intestinal ischemia and necrosis in acute bowel obstruction.

Methods

We performed a prospective study of 242 patients with small- or large-bowel obstructions in 2005. A total of 100 patients who underwent operation were divided into groups according to the presence of ischemia (reversible and irreversible) and necrosis, respectively, as follows: ischemia (n = 35) and nonischemia groups (n = 65) and necrosis (n = 22) and nonnecrosis groups (n = 78). Data analyzed included age, sex, vital signs, symptoms, clinical findings, white blood cell count, base deficit, metabolic acidosis, procalcitonin levels on presentation, the time between symptom onset and arrival at the emergency department and the time between arrival and operation, and the cause of the obstruction.

Results

Procalcitonin levels were greater in the ischemia than the nonischemia group (9.62 vs 0.30 ng/mL; P = .0001) and in the necrosis than the non-necrosis group (14.53 vs 0.32 ng/mL; P = .0001). Multivariate analysis identified procalcitonin as an independent predictor of ischemia (P = .009; odds ratio, 2.252; 95% confidence interval, 1.225-4.140) and necrosis (P = .005; odds ratio, 2.762; 95% confidence interval, 1.356-5.627). Using receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) of procalcitonin for ischemia and necrosis was 0.77 and 0.87, respectively. A high negative predictive value for ischemia and necrosis of procalcitonin levels <0.25 ng/mL (83% and 95%, respectively) and a positive predictive value of procalcitonin >1 ng/mL were identified (95% and 90%, respectively).

Conclusion

Procalcitonin on presentation is very useful for the diagnosis or exclusion of intestinal ischemia and necrosis in acute bowel obstruction and could serve as an additional diagnostic tool to improve clinical decision-making.

Section snippets

Study design and population

All adult (over 14 years of age) patients admitted to our department with a diagnosis of acute complete mechanical small- or large-bowel obstruction from January to December 2005 were included in this prospective study. Institutional Review Board approval was obtained before study initiation, and written informed consent was obtained by all patients before enrollment in the study. Patients with incomplete obstruction, paralytic ileus, and acute mesenteric ischemia were excluded. There was no

Results

Our hospital has a total of 800 beds, 100 of which are surgical. In our department, approximately 2,000 operations are performed per year. During the 1-year period of our study, 242 consecutive patients with acute small- or large-bowel obstruction were admitted and comprised our total study population. Mechanical bowel obstruction was confirmed in all operatively treated patients and in all patients undergoing CT. The majority of the 242 patients (n = 183; 75.6%) had small bowel obstruction.

Discussion

Acute bowel obstruction is a major cause of morbidity and financial expenditure in hospitals and a notable cause of admissions to emergency surgical departments.1, 2, 3, 4, 5 Diagnosis of bowel strangulation is based traditionally on classic signs, namely, tachycardia, hypotension, fever, constant pain, peritoneal signs, leukocytosis, base deficit, and metabolic acidosis.6, 9, 11, 12, 13, 14, 26 Abdominal CT is also useful.14, 27 Prompt, appropriate treatment of this condition is critical;

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