title: Evaluation of procalcitonin as a biomarker of diagnosis, severity and postoperative complications in adult patients with acute appendicitis.
abstract: BACKGROUND
  Delay in diagnosis and treatment of acute appendicitis (AA) results in an increased rate of perforation, postoperative morbidity, mortality and hospital length of stay. Several biochemical parameters including white blood cell (WBC) count, C-reactive protein (CRP), interleukin-6 (IL6) and Procalcitonin (PCT) have been used to further improve the clinical diagnosis of AA. The aim of this study was to assess the value of procalcitonin as a predictor of diagnosis and severity of appendicitis in order to improve the clinical decision making, since other studies have been unable to demonstrate a diagnostic value for PCT elevation in acute appendicitis.
  
  
  METHODS
  One-hundred patients who underwent open appendectomy, including 75 men and 25 women with a mean age of 28 years were included in this study. Procalcitonin values were measured by an immunofluorescent method). Serum PCT>0.5 ng/ml was considered positive. The PCT serum values were measured in four different categories, including ˂0.5ng/ml, 0.5-2 ng/ml, 2-10ng/ml and more than 10ng/ml.
  
  
  RESULTS
  The sensitivity and specificity of PCT level measurement for acute appendicitis diagnosis were 44% and 100% respectively. The value of PCT increased with the severity of appendicitis and also with the presence of peritonitis and infection, at the site of surgery.
  
  
  CONCLUSIONS
  Procalcitonin measurement cannot be used as a diagnostic test for adult patients with acute appendicitis and its routine use in such patients is not cost effective and conclusive. Procalcitonin values can be used as a prognostic marker and predictor of infectious complications following surgery and it can help to carry out timely surgical intervention which is highly recommended in patients with PCT values more than 0.5ng/ml.
authors.affiliation: 1. MD, Associate Professor of Thoracic Surgery, Minimally Invasive Surgery Research center, Iran University of Medical Sciences, Tehran, Iran. dr_m_vaziri@yahoo.com.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Vaziri
authors.affiliation: 2. MD, Associate Professor of Pediatrics, Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Fahimeh
authors.initials: F
authors.lastname: Ehsanipour
authors.affiliation: 3. MD, Assistant Professor of Laparoscopy, Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran. apazouki@yahoo.com.
authors.forename: Abdolreza
authors.initials: A
authors.lastname: Pazouki
authors.affiliation: 4. MD, General Practitioner, Minimally Invasive Surgery Research center, Iran University of Medical Sciences, Tehran, Iran. research_center88@yahoo.com & zeinab_tamannaie@yahoo.com.
authors.forename: Zeinab
authors.initials: Z
authors.lastname: Tamannaie
authors.affiliation: 5. MD, General Surgeon, Minimally Invasive Surgery Research center, Iran University of Medical Sciences, Tehran, Iran. research_center88@yahoo.com.
authors.forename: Roohollah
authors.initials: R
authors.lastname: Taghavi
authors.affiliation: 6. BS, Statistics Analyzer, Minimally Invasive Surgery Research center, Iran University of Medical Sciences, Tehran, Iran. mo.pishgah@gmail.com.
authors.forename: Mohaddese
authors.initials: M
authors.lastname: Pishgahroudsari
authors.affiliation: 7. MD, Research manager, Minimally Invasive Surgery Research center, Iran University of Medical Sciences, Tehran, Iran. fatemehjesmi@yahoo.com.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Jesmi
authors.affiliation: 8. MD, Associate Professor of Gynecology, Director of Minimally Invasive Techniques Research Center, Islamic Azad University, Tehran Medical Unit, Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran. shahlachaichian@yahoo.com.
authors.forename: Shahla
authors.initials: S
authors.lastname: Chaichian
keywords: Appendicitis; Diagnosis; Procalcitonin; Prognosis