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
Figure 1
Sensitivity values of inflammatory markers.
Figure 2
Figure 2
Specificity values of inflammatory markers.
Figure 3
Figure 3
Comparison of phlegmenous and perforated appendectomy group ROC curve for PCT (cut off value

Figure 4

Comparison of phlegmenous and perforated…

Figure 4

Comparison of phlegmenous and perforated group ROC curve for CRP (cut off value…

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…

Figure 5
Comparison of phlegmenous and perforated group ROC curve for D-dimer (cut of value
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    1. 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
    1. 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
    1. Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993;341:515– 518. - PMC - PubMed
    1. Maruna P, Frasko R, Gürlich R. Plasma procalcitonin in patients with ileus. Relations to other inflammatory parameters. Physiol Res. 2008;57:481–6. - PubMed
    1. 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
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Figure 4
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…

Figure 5
Comparison of phlegmenous and perforated group ROC curve for D-dimer (cut of value
Similar articles
Cited by
References
    1. 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
    1. 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
    1. Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993;341:515– 518. - PMC - PubMed
    1. Maruna P, Frasko R, Gürlich R. Plasma procalcitonin in patients with ileus. Relations to other inflammatory parameters. Physiol Res. 2008;57:481–6. - PubMed
    1. 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
Show all 33 references
MeSH terms
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Figure 5
Figure 5
Comparison of phlegmenous and perforated group ROC curve for D-dimer (cut of value

References

    1. 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.
    1. 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.
    1. Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993;341:515– 518.
    1. Maruna P, Frasko R, Gürlich R. Plasma procalcitonin in patients with ileus. Relations to other inflammatory parameters. Physiol Res. 2008;57:481–6.
    1. 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.
    1. Tillet WS, Francis T. Jr. Serological Reactions in pneumonia with a non-protein somatic fraction of pneumococcus. J Exp Med. 1930;52:561–71.
    1. Eriksson S, Granstrom L. Laboratory tests in patients with suspected acute appendicitis. Acta Chir Scand. 1994;155:117–2.
    1. Shakhatreh HS. The accuracy of C-reactive protein in the diagnosis of acute appendicitis compared with that of clinical diagnosis. Med Arh. 2000;54:109–10.
    1. Colson M, Skinner KA, Dunnignton G. High negative appendectomy rates are no longer acceptable. Am J Surg. 1997;174:723–6.
    1. Espinoza R, Ohmke J, García-Huidobro I, Guzmán S, Azocar M. Negative appendectomy: experience at a universty hospital. Rev Med Chil. 1998;126:75–80.
    1. Fingerhut A, Yahchouchy-Chouillard E, Etrenne JC. Appendicitis or nonspesific pain in the right iliac fossa. Rev Prot. 2001;51:1654–6.
    1. Agrawal CS, Adhikari S, Kumar M. Role of serum C-reactive protein and leukocyte count in the diagnosis of acute appendicitis in Nepalese population. Nepal Med Coll J. 2008;10:11–5.
    1. Grönroos JM, Forsström JJ, Irjala K, Nevalainen TJ. Phospholipase A2, C-reactive protein, and white blood cell count in the diagnosis of acute appendicitis. Clin Chem. 1994;40:1757– 60.
    1. Lycopoulou L, Mamoulakis C, Hantzi E, Demetriadis D, Antypas S, Giannaki M, Bakoula C, Chrousos G, Papassotiriou I. Serum amyloid A protein levels as a possible aid in the diagnosis of acute appendicitis in children. Clin Chem Lab Med. 2005;43:49– 53.
    1. Dalal I, Somekh E, Bilker-Reich A, Boaz M, Gorenstein A, Serour F. Serum and peritoneal inflammatory mediators in children with suspected acute appendicitis. Arch Surg. 2005;140:169– 73.
    1. Hatherill M, Jones G, Lim E, Tibby SM, Murdoch IA. Procalcitonin aids diagnosis of adrenocortical failure. Lancet. 1997;350:1749–50.
    1. Sand M, Trullen XV, Bechara FG, Pala XF, Sand D, Landgrafe G, Mann B. A prospective bicenter study investigating the diagnostic value of procalcitonin in patients with acute appendicitis. Eur Surg Res. 2009;43:291–7.
    1. Kouame DB, Garrigue MA, Lardy H, Machet MC, Giraudeau B, Robert M. Is procalcitonin able to help in pediatric appendicitis diagnosis? Ann Chir. 2005;130:169–74.
    1. Aslan A, Karaveli C, Ogunc D, Elpek O, Karaguzel G, Melikoglu M. Does noncomplicated acute appendicitis cause bacterial translocation? Pediatr Surg Int. 2007;23:555–558.
    1. Harrison KA, Haire WD, Pappas AA, Purnell GL, Palmer S, Holdeman KP, Fink LM, Dalrymple GV. Plasma D-Dimer: a useful tool for evaluating suspected pulmonary embolus. J Nucl Med. 1993;34:896–8.
    1. Meissner MH, Zierler BK, Bergelin RO, Chandler WC, Manzo RA, Strandness DE Jr. Markers of plasma coagulation and fibrinolysis after acute deep venous thrombosis. J Vasc Surg. 2000;32:870–80.
    1. Bayes-Genis A, Mateo J, Santaló M, Oliver A, Guindo J, Badimon L. D-Dimer is an early diagnostic marker of coronary ischemia in patients with chest pain. Am Heart J. 2000;140:379–84.
    1. Engelman DT, Gabram SG, Allen L, Ens GE, Jacobs LM. Hypercoagulability following multiple trauma. World J Surg. 1996;20:5–10.
    1. Raimondi P, Bongard O, de Moerloose P, Reber G, Waldvogel F, Bounameaux H. D-dimer plasma concentration in various clinical conditions: Implication for the use of this test in the diagnostic approach of venous thromboembolism. Thromb Res. 1993;69:125– 30.
    1. Kurt Y, Akin ML, Demirbas S, Uluutku AH, Gulderen M, Avsar K, Celenk T. D-dimer in the early diagnosis of acute mesenteric ischemia secondary to arterial occlusion in rats. Eur Surg Res. 2005;37:216–9.
    1. Akyildiz HY, Sözüer E, Akcan A, Küçük C, Artis T, Biri I, Yilmaz N. The value of D- dimer test in the diagnosis of patients with nontraumatic acute abdomen. Ulus Travma Acil Cerrahi Derg. 2010;16:22–6.
    1. Mentes O, Eryilmaz M, Harlak A, Ozer T, Balkan M, Kozak O, Tufan T. D-dimer become a new diagnostic parameter for acute appendicitis? Am J Emerg Med. 2009;27:765–9.
    1. al-Saigh AH. C-reactive protein in the differential diagnosis of the acute abdomen, especially acute appendicitis. J R Coll Surg Edinb. 1992;37:238–40.
    1. Gurleyik E, Gurleyik G, Unalmiser S. Accuracy of serum C-reactive protein measurements in diagnosis of acute appendicitis compared with surgeon's clinical impression. Dis Colon Rectum. 1995;38:1270–4.
    1. Yang HR, Wang YC, Chung PK, Chen WK, Jeng LB, Chen RJ. Role of leukocyte count, neutrophil percentage, and C-reactive protein in the diagnosis of acute appendicitis in the elderly. Am Surg. 2005;71:344–7.
    1. Hallan S. Asberg A. The accuracy of C-reactive protein in diagnosing acute appendicitis- a meta-analysis. Scand J Clin Lab Invest. 1997;57:373–80.
    1. Grönroos JM, Grönroos P. Leucocyte count and C-reactive protein in the diagnosis of acute appendicitis. Br J Surg. 1999;86:501–4.
    1. Ortega-Deballon P, Ruiz de Adana-Belbel JC, Hernández-Matías A, García-Septiem J, Moreno-Azcoita M. Usefulness of laboratory data in the management of right iliac fossa pain in adults. Dis Colon Rectum. 2008;51:1093–9.

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