Published online Jun 28, 2017. doi: 10.3748/wjg.v23.i24.4422
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
Processing time: 116 Days and 23.4 Hours
To assess the accuracy of serum procalcitionin (PCT) as a diagnostic marker in verifying upper and lower gastrointestinal perforation (GIP).
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.
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%.
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.