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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Procalcitionin as a diagnostic marker to distinguish upper and lower gastrointestinal perforation
Yang Gao, Kai-Jiang Yu, Kai Kang, Hai-Tao Liu, Xing Zhang, Rui Huang, Jing-Dong Qu, Si-Cong Wang, Rui-Jin Liu, Yan-Song Liu, Hong-Liang Wang
Yang Gao, Xing Zhang, Rui Huang, Jing-Dong Qu, Si-Cong Wang, Rui-Jin Liu, Hong-Liang Wang, Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
Kai-Jiang Yu, Hai-Tao Liu, Yan-Song Liu, Department of Critical Care Medicine, the Cancer Hospital of Harbin Medical University, Harbin 150081, Heilongjiang Province, China
Kai-Jiang Yu, Institute of Critical Care Medicine in Sino Russian Medical Research Center of Harbin Medical University, Harbin 150081, Heilongjiang Province, China
Kai Kang, Department of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
Author contributions: Gao Y and Yu KJ contributed equally to this work; Gao Y, Yu KJ, Kang K and Wang HL carried out the studies, participated in data collection, and drafted the manuscript; Liu HT, Zhang X, Huang R, Qu JD, Wang SC, Liu RJ and Liu YS performed the statistical analyses and participated in study design; all authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81571871.
Institutional review board statement: The study was approved by the Ethics Committee of Harbin Medical University.
Informed consent statement: All clinical data were collected with informed consent obtained from study participants.
Conflict-of-interest statement: All authors declare that they have no any conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hong-Liang Wang, MD, Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Harbin 150086, Heilongjiang Province, China. icuwanghongliang@163.com
Telephone: +86-21-57643271 Fax: +86-21-57643271
Received: March 1, 2017
Peer-review started: March 2, 2017
First decision: April 10, 2017
Revised: April 19, 2017
Accepted: May 19, 2017
Article in press: May 19, 2017
Published online: June 28, 2017
AIM
To assess the accuracy of serum procalcitionin (PCT) as a diagnostic marker in verifying upper and lower gastrointestinal perforation (GIP).
METHODS
This retrospective study included 46 patients from the surgical intensive care unit (ICU) of the Second Affiliated Hospital of Harbin Medical University who were confirmed to have GIP between June 2013 and December 2016. Demographic and clinical patient data were recorded on admission to ICU. Patients were divided into upper (n = 19) and lower (n = 27) GIP groups according to the perforation site (above or below Treitz ligament). PCT and WBC count was obtained before laparotomy and then compared between groups. Meanwhile, the diagnostic accuracy of PCT was analyzed.
RESULTS
Patients with lower GIP exhibited significantly higher APACHE II score, SOFA score and serum PCT level than patients with upper GIP (P = 0.017, 0.004, and 0.001, respectively). There was a significant positive correlation between serum PCT level and APACHE II score or SOFA score (r = 0.715 and r = 0.611, respectively), while there was a significant negative correlation between serum PCT level and prognosis (r = -0.414). WBC count was not significantly different between the two groups, and WBC count showed no significant correlation with serum PCT level, APACHE II score, SOFA score or prognosis. The area under the receiver operating characteristic curve of PCT level to distinguish upper or lower GIP was 0.778. Patients with a serum PCT level above 17.94 ng/dL had a high likelihood of lower GIP, with a sensitivity of 100% and a specificity of 42.1%.
CONCLUSION
Serum PCT level is a reliable and accurate diagnostic marker in identifying upper or lower GIP before laparotomy.
Core tip: Procalcitionin (PCT) is a rapid, reliable and accurate predictive marker and contributes to assisting the clinicians in identifying upper or lower gastrointestinal perforation (GIP) before laparotomy, and it can be used as a useful supplementary tool for early clinical judgment of perforation site. The results showed that patients with lower GIP exhibited significantly higher APACHE II score, SOFA score and serum PCT level than patients with upper GIP, which might be related to the differences in bacterial load and the severity of sepsis between upper and lower GIP.
