The diagnostic value of D-dimer, procalcitonin and CRP in acute appendicitis
Bulent Kaya, Baris Sana, Cengiz Eris, Koray Karabulut, Orhan Bat, Riza Kutanis, Bulent Kaya, Baris Sana, Cengiz Eris, Koray Karabulut, Orhan Bat, Riza Kutanis
Abstract
Background: The early diagnosis of acute abdomen is of great importance. To date, several inflammatory markers have been used for the diagnosis of acute abdominal conditions, including acute appendicitis. The aim of this study was to evaluate the diagnostic utility of D-dimer, Procalcitonin (PCT) and C-reactive protein (CRP) measurements in the acute appendicitis.
Methods: This prospective study was conducted between March 1(st), 2010 and July 1(st), 2011. In this period, seventy-eight patients were operated with the diagnosis of acute appendicitis, and D-dimer, PCT and CRP levels of the patients were measured. The patients were grouped as phlegmonous appendicitis (Group 1), gangrenous appendicitis (Group 2), perforated appendicitis (Group 3) and negative appendectomy (Group 4) according to the surgical findings and histopathological results.
Results: Of 78 patients, 54 (69.2 %) were male and 24 (30.8 %) were female, and the mean age was 25.4 ± 11.1 years (range, 18 to 69 years). 66 (84.6 %) patients had increased leukocyte count (white blood cell count). The PCT values were higher than the upper normal limit in 20 (25.6%) patients, followed by D-dimer in 22 (28.2 %) patients and CRP in 54 (69.2 %) patients. The diagnostic value of leukocyte count and CRP in acute appendicitis was higher than that of the other markers, whereas leukocyte count showed very low specificity. CRP values were higher in perforated appendicitis when compared with the phlegmonous appendicitis (p < 0.05). However, PCT and D-dimer showed lower diagnostic values (26% and 31%, respectively).
Conclusion: An increase in CRP levels alone is not sufficient to make the diagnosis of acute appendicitis. However, CRP levels may differentiate between phlegmonous appendicitis and perforated appendicitis. Due to their low sensitivity and diagnostic value, PCT and D-dimer are not better markers than CRP for the diagnosis of acute appendicitis.
Keywords: Appendicitis; C-reactive protein.; D-dimer; Procalcitonin.
Conflict of interest statement
Competing Interests: The authors have declared that no competing interest exists.
Figures
![Figure 1](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/3520016/bin/ijmsv09p0909g01.jpg)
![Figure 2](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/3520016/bin/ijmsv09p0909g02.jpg)
![Figure 3](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/3520016/bin/ijmsv09p0909g03.jpg)
Figure 4
Comparison of phlegmenous and perforated…
Figure 4
Comparison of phlegmenous and perforated group ROC curve for CRP (cut off value…
Figure 5
Comparison of phlegmenous and perforated…
Figure 5
Comparison of phlegmenous and perforated group ROC curve for D-dimer (cut of value…
- [Diagnostic value of a combination of biomarkers in patients with sepsis and severe sepsis in emergency department].Zhao Y, Li C. Zhao Y, et al. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2014 Mar;26(3):153-8. doi: 10.3760/cma.j.issn.2095-4352.2014.03.006. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2014. PMID: 24598287 Chinese.
- An evaluation of the utility of additional tests in the preoperative diagnostics of acute appendicitis.Anielski R, Kuśnierz-Cabala B, Szafraniec K. Anielski R, et al. Langenbecks Arch Surg. 2010 Nov;395(8):1061-8. doi: 10.1007/s00423-009-0565-x. Epub 2009 Nov 19. Langenbecks Arch Surg. 2010. PMID: 19924436
- A prospective bicenter study investigating the diagnostic value of procalcitonin in patients with acute appendicitis.Sand M, Trullen XV, Bechara FG, Pala XF, Sand D, Landgrafe G, Mann B. Sand M, et al. Eur Surg Res. 2009;43(3):291-7. doi: 10.1159/000232939. Epub 2009 Aug 7. Eur Surg Res. 2009. PMID: 19672084 Free PMC article. Clinical Trial.
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- Serum procalcitonin and C-reactive protein levels as markers of bacterial infection in patients with liver cirrhosis: a systematic review and meta-analysis.Lin KH, Wang FL, Wu MS, Jiang BY, Kao WL, Chao HY, Wu JY, Lee CC. Lin KH, et al. Diagn Microbiol Infect Dis. 2014 Sep;80(1):72-8. doi: 10.1016/j.diagmicrobio.2014.03.029. Epub 2014 May 21. Diagn Microbiol Infect Dis. 2014. PMID: 24974271 Review.
- The Use of Procalcitonin in the Diagnosis of Acute Appendicitis: A Systematic Review.Dale L. Dale L. Cureus. 2022 Oct 14;14(10):e30292. doi: 10.7759/cureus.30292. eCollection 2022 Oct. Cureus. 2022. PMID: 36407148 Free PMC article. Review.
- Negative Appendicectomy Rates in Females of Childbearing Age: A Retrospective Analysis and Literature Review.Hatem F, Baig H, Khaldas F, Lucocq J. Hatem F, et al. Cureus. 2022 Jul 28;14(7):e27412. doi: 10.7759/cureus.27412. eCollection 2022 Jul. Cureus. 2022. PMID: 36051710 Free PMC article.
- Role of inflammatory and hematological markers in predicting the complicated and perforated acute appendicitis in pediatric population: A cohort study.Haider Kazmi SJ, Tabassum S, Asghar MS, Siddiqui MA, Avinash, Yasmin F, Tahir MJ, Aziz Y, Kirmani TA, Ahmed M. Haider Kazmi SJ, et al. Ann Med Surg (Lond). 2022 Apr 1;76:103524. doi: 10.1016/j.amsu.2022.103524. eCollection 2022 Apr. Ann Med Surg (Lond). 2022. PMID: 35495380 Free PMC article.
- Safety and efficacy of autologous non-hematopoietic enriched stem cell nebulization in COVID-19 patients: a randomized clinical trial, Abu Dhabi 2020.Ventura-Carmenate Y, Alkaabi FM, Castillo-Aleman YM, Villegas-Valverde CA, Ahmed YM, Sanna P, Almarzooqi AA, Abdelrazik A, Torres-Zambrano GM, Wade-Mateo M, Quesada-Saliba D, Abdel Hadi L, Bencomo-Hernandez AA, Rivero-Jimenez RA. Ventura-Carmenate Y, et al. Transl Med Commun. 2021;6(1):25. doi: 10.1186/s41231-021-00101-5. Epub 2021 Nov 3. Transl Med Commun. 2021. PMID: 34746417 Free PMC article.
- Preoperatively predicting the pathological types of acute appendicitis using machine learning based on peripheral blood biomarkers and clinical features: a retrospective study.Kang CB, Li XW, Hou SY, Chi XQ, Shan HF, Zhang QJ, Li XB, Zhang J, Liu TJ. Kang CB, et al. Ann Transl Med. 2021 May;9(10):835. doi: 10.21037/atm-20-7883. Ann Transl Med. 2021. PMID: 34164469 Free PMC article.
-
- Ivancević N, Radenković D, Bumbasirević V, Karamarković A, Jeremić V, Kalezić N, Vodnik T, Beleslin B, Milić N, Gregorić P, Zarković M. Procalcitonin in preoperative diagnosis of abdominal sepsis. Langenbecks Arch Surg. 2008;393:397–403. - PubMed
-
- Le Moullec JM, Jullienne A, Chenais J, Lasmoles F, Guliana JM, Milhaud G, Moukhtar MS. The complete sequence of human preprocalcitonin. FEBS Lett. 1984;13:93–7. - PubMed
-
- Maruna P, Frasko R, Gürlich R. Plasma procalcitonin in patients with ileus. Relations to other inflammatory parameters. Physiol Res. 2008;57:481–6. - PubMed
-
- Markogiannakis H, Memos N, Messaris E, Dardamanis D, Larentzakis A, Papanikolaou D, Zografos GC, Manouras A. Predictive value of procalcitonin for bowel ischemia and necrosis in bowel obstruction. Surgery. 2011 Mar;149(3):394–403. - PubMed
- Adolescent
- Adult
- Aged
- Appendicitis* / blood
- Appendicitis* / classification
- Appendicitis* / metabolism
- Biomarkers / blood
- C-Reactive Protein / metabolism*
- Calcitonin / blood*
- Calcitonin Gene-Related Peptide
- Female
- Fibrin Fibrinogen Degradation Products / metabolism*
- Humans
- Leukocyte Count
- Male
- Middle Aged
- Protein Precursors / blood*
- Biomarkers
- CALCA protein, human
- Fibrin Fibrinogen Degradation Products
- Protein Precursors
- fibrin fragment D
- Calcitonin
- C-Reactive Protein
- Calcitonin Gene-Related Peptide
- Full Text Sources
- Other Literature Sources
- Medical
- Research Materials
- Miscellaneous
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![Figure 4](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/3520016/bin/ijmsv09p0909g04.jpg)
Figure 5
Comparison of phlegmenous and perforated…
Figure 5
Comparison of phlegmenous and perforated group ROC curve for D-dimer (cut of value…
- [Diagnostic value of a combination of biomarkers in patients with sepsis and severe sepsis in emergency department].Zhao Y, Li C. Zhao Y, et al. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2014 Mar;26(3):153-8. doi: 10.3760/cma.j.issn.2095-4352.2014.03.006. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2014. PMID: 24598287 Chinese.
- An evaluation of the utility of additional tests in the preoperative diagnostics of acute appendicitis.Anielski R, Kuśnierz-Cabala B, Szafraniec K. Anielski R, et al. Langenbecks Arch Surg. 2010 Nov;395(8):1061-8. doi: 10.1007/s00423-009-0565-x. Epub 2009 Nov 19. Langenbecks Arch Surg. 2010. PMID: 19924436
- A prospective bicenter study investigating the diagnostic value of procalcitonin in patients with acute appendicitis.Sand M, Trullen XV, Bechara FG, Pala XF, Sand D, Landgrafe G, Mann B. Sand M, et al. Eur Surg Res. 2009;43(3):291-7. doi: 10.1159/000232939. Epub 2009 Aug 7. Eur Surg Res. 2009. PMID: 19672084 Free PMC article. Clinical Trial.
- Systematic review and meta-analysis of the diagnostic accuracy of procalcitonin, C-reactive protein and white blood cell count for suspected acute appendicitis.Yu CW, Juan LI, Wu MH, Shen CJ, Wu JY, Lee CC. Yu CW, et al. Br J Surg. 2013 Feb;100(3):322-9. doi: 10.1002/bjs.9008. Epub 2012 Nov 30. Br J Surg. 2013. PMID: 23203918 Review.
- Serum procalcitonin and C-reactive protein levels as markers of bacterial infection in patients with liver cirrhosis: a systematic review and meta-analysis.Lin KH, Wang FL, Wu MS, Jiang BY, Kao WL, Chao HY, Wu JY, Lee CC. Lin KH, et al. Diagn Microbiol Infect Dis. 2014 Sep;80(1):72-8. doi: 10.1016/j.diagmicrobio.2014.03.029. Epub 2014 May 21. Diagn Microbiol Infect Dis. 2014. PMID: 24974271 Review.
- The Use of Procalcitonin in the Diagnosis of Acute Appendicitis: A Systematic Review.Dale L. Dale L. Cureus. 2022 Oct 14;14(10):e30292. doi: 10.7759/cureus.30292. eCollection 2022 Oct. Cureus. 2022. PMID: 36407148 Free PMC article. Review.
- Negative Appendicectomy Rates in Females of Childbearing Age: A Retrospective Analysis and Literature Review.Hatem F, Baig H, Khaldas F, Lucocq J. Hatem F, et al. Cureus. 2022 Jul 28;14(7):e27412. doi: 10.7759/cureus.27412. eCollection 2022 Jul. Cureus. 2022. PMID: 36051710 Free PMC article.
- Role of inflammatory and hematological markers in predicting the complicated and perforated acute appendicitis in pediatric population: A cohort study.Haider Kazmi SJ, Tabassum S, Asghar MS, Siddiqui MA, Avinash, Yasmin F, Tahir MJ, Aziz Y, Kirmani TA, Ahmed M. Haider Kazmi SJ, et al. Ann Med Surg (Lond). 2022 Apr 1;76:103524. doi: 10.1016/j.amsu.2022.103524. eCollection 2022 Apr. Ann Med Surg (Lond). 2022. PMID: 35495380 Free PMC article.
- Safety and efficacy of autologous non-hematopoietic enriched stem cell nebulization in COVID-19 patients: a randomized clinical trial, Abu Dhabi 2020.Ventura-Carmenate Y, Alkaabi FM, Castillo-Aleman YM, Villegas-Valverde CA, Ahmed YM, Sanna P, Almarzooqi AA, Abdelrazik A, Torres-Zambrano GM, Wade-Mateo M, Quesada-Saliba D, Abdel Hadi L, Bencomo-Hernandez AA, Rivero-Jimenez RA. Ventura-Carmenate Y, et al. Transl Med Commun. 2021;6(1):25. doi: 10.1186/s41231-021-00101-5. Epub 2021 Nov 3. Transl Med Commun. 2021. PMID: 34746417 Free PMC article.
- Preoperatively predicting the pathological types of acute appendicitis using machine learning based on peripheral blood biomarkers and clinical features: a retrospective study.Kang CB, Li XW, Hou SY, Chi XQ, Shan HF, Zhang QJ, Li XB, Zhang J, Liu TJ. Kang CB, et al. Ann Transl Med. 2021 May;9(10):835. doi: 10.21037/atm-20-7883. Ann Transl Med. 2021. PMID: 34164469 Free PMC article.
-
- Ivancević N, Radenković D, Bumbasirević V, Karamarković A, Jeremić V, Kalezić N, Vodnik T, Beleslin B, Milić N, Gregorić P, Zarković M. Procalcitonin in preoperative diagnosis of abdominal sepsis. Langenbecks Arch Surg. 2008;393:397–403. - PubMed
-
- Le Moullec JM, Jullienne A, Chenais J, Lasmoles F, Guliana JM, Milhaud G, Moukhtar MS. The complete sequence of human preprocalcitonin. FEBS Lett. 1984;13:93–7. - PubMed
-
- Maruna P, Frasko R, Gürlich R. Plasma procalcitonin in patients with ileus. Relations to other inflammatory parameters. Physiol Res. 2008;57:481–6. - PubMed
-
- Markogiannakis H, Memos N, Messaris E, Dardamanis D, Larentzakis A, Papanikolaou D, Zografos GC, Manouras A. Predictive value of procalcitonin for bowel ischemia and necrosis in bowel obstruction. Surgery. 2011 Mar;149(3):394–403. - PubMed
- Adolescent
- Adult
- Aged
- Appendicitis* / blood
- Appendicitis* / classification
- Appendicitis* / metabolism
- Biomarkers / blood
- C-Reactive Protein / metabolism*
- Calcitonin / blood*
- Calcitonin Gene-Related Peptide
- Female
- Fibrin Fibrinogen Degradation Products / metabolism*
- Humans
- Leukocyte Count
- Male
- Middle Aged
- Protein Precursors / blood*
- Biomarkers
- CALCA protein, human
- Fibrin Fibrinogen Degradation Products
- Protein Precursors
- fibrin fragment D
- Calcitonin
- C-Reactive Protein
- Calcitonin Gene-Related Peptide
- Full Text Sources
- Other Literature Sources
- Medical
- Research Materials
- Miscellaneous
![Figure 5](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/3520016/bin/ijmsv09p0909g05.jpg)
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