title: Accurate diagnosis of acute abdomen in FMF and acute appendicitis patients: how can we use procalcitonin?
abstract: 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.
authors.affiliation: 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.
authors.forename: Bunyamin
authors.initials: B
authors.lastname: Kisacik
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Umut
authors.initials: U
authors.lastname: Kalyoncu
authors.affiliation: 4th Surgery Clinic, Ankara Education and Research Hospital, Ministry of Health, Ankara, Turkey.
authors.forename: M Fatih
authors.initials: MF
authors.lastname: Erol
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Omer
authors.initials: O
authors.lastname: Karadag
authors.affiliation: 4th Surgery Clinic, Ankara Education and Research Hospital, Ministry of Health, Ankara, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Yildiz
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Akdogan
authors.affiliation: 4th Surgery Clinic, Ankara Education and Research Hospital, Ministry of Health, Ankara, Turkey.
authors.forename: Bugra
authors.initials: B
authors.lastname: Kaptanoglu
authors.affiliation: Department of Preventive Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Mutlu
authors.initials: M
authors.lastname: Hayran
authors.affiliation: Rheumatology Clinic, Ankara Education and Research Hospital, Ministry of Health, Ankara, Turkey.
authors.forename: Kemal
authors.initials: K
authors.lastname: Ureten
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Ihsan
authors.initials: I
authors.lastname: Ertenli
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Sedat
authors.initials: S
authors.lastname: Kiraz
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Meral
authors.initials: M
authors.lastname: Calguneri
mesh_terms: 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
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D006023:Glycoproteins; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide