Accurate diagnosis of acute abdomen in FMF and acute appendicitis patients: how can we use procalcitonin?
This study was conducted to define the value of procalcitonin (PCT) levels in the differential diagnosis of abdominal familial Mediterranean fever (FMF) attacks from acute appendicitis. From October 2006 to January 2007, 28 FMF (12 males, 16 females) patients with acute abdominal attacks and 34 patients (18 males) with acute abdomen who underwent operation with the clinical diagnosis of acute appendicitis were consecutively enrolled in this study. FMF patients with concurrent infectious diseases were excluded. PCT values were measured by an immunofluorescent method using the B.R.A.H.M.S. PCT kit (B.R.A.H.M.S. Diagnostica, Berlin, Germany). Erythrocyte sedimentation rate (ESR), C-reactive proteins (CRP) and leucocyte levels were also noted. Mean disease duration in FMF patients was 9.6 +/- 8.1 years (range 2-33 years) and all were on colchicine therapy with a mean colchicine dosage of 1.2 +/- 0.4 mg/day. Among the operated patients, 5 were excluded: 3 patients had normal findings and 2 had intestinal perforation (PCT levels were 2.69 and 4.93 ng/ml, respectively) at operative and pathologic evaluation. There were no significant differences between the two groups with respect to gender and age (p was not significant (NS) for all). Acute phase reactants and PCT levels were increased in patients with FMF compared to patients with acute appendicitis (0.529[0.12 +/- 0.96] vs 0.095 [0.01-0.80] p < 0.001, respectively). PCT levels higher than 0.5 ng/ml were found in 11% (3/28) of FMF patients compared to 62% (18/29) of acute appendicitis patients (p < 0.001). Our results suggest that PCT could be a useful test in the differentiation of abdominal FMF attacks from acute appendicitis, though it should not supplant more conventional investigations.
Kisacik
Bunyamin
B
Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey. bunyamin_k@hotmail.com.|Hacettepe Universitesi Tip Fakultesi Romatoloji Unitesi, 06100, Sihhiye, Ankara, Turkey. bunyamin_k@hotmail.com.
Kalyoncu
Umut
U
Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Erol
M Fatih
MF
4th Surgery Clinic, Ankara Education and Research Hospital, Ministry of Health, Ankara, Turkey.
Karadag
Omer
O
Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Yildiz
Mustafa
M
4th Surgery Clinic, Ankara Education and Research Hospital, Ministry of Health, Ankara, Turkey.
Akdogan
Ali
A
Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Kaptanoglu
Bugra
B
4th Surgery Clinic, Ankara Education and Research Hospital, Ministry of Health, Ankara, Turkey.
Hayran
Mutlu
M
Department of Preventive Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Ureten
Kemal
K
Rheumatology Clinic, Ankara Education and Research Hospital, Ministry of Health, Ankara, Turkey.
Ertenli
Ihsan
I
Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Kiraz
Sedat
S
Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Calguneri
Meral
M
Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
D000006:Abdomen, Acute / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D000328:Adult; D001064:Appendicitis / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D003937:Diagnosis, Differential; D010505:Familial Mediterranean Fever / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D005260:Female; D015200:Fluoroimmunoassay; D006023:Glycoproteins; D006801:Humans; D008297:Male; D011498:Protein Precursors / Q000097:blood*; D015203:Reproducibility of Results; D012189:Retrospective Studies
D015415:Biomarkers; C000606589:CALCA protein, human; D006023:Glycoproteins; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide