title: Role of inflammatory markers as predictors of laparotomy in patients presenting with acute abdomen.
abstract: BACKGROUND
  There is a need for an ideal indicator of surgery in patients presenting with acute abdomen. Several markers have been analysed, but the search still continues as none have proven effective. This study aimed to analyse and compare the predictive value of plasma procalcitonin (PCT) strip test in patients presenting with acute abdomen and identify a useful cut-off value to differentiate patients that would benefit with surgery from those that require conservative management.
  
  
  METHODS
  A prospective study was conducted in the department of general surgery from June 2012 to June 2013. Plasma PCT was estimated by the semi-quantitative strip test. The levels of plasma PCT and other routinely used markers of inflammation were analysed and compared.
  
  
  RESULTS
  Of the total of 58 patients, 44 patients (76%) were men with a mean age of 45 years. Forty patients required emergency surgical intervention. A plasma PCT value of >0.5 ng/mL at admission was 80% sensitive and 100% specific for predicting need for antibiotics in patients with acute abdomen that were managed conservatively. The mean plasma PCT value in the patients undergoing surgery (5.0-10.0 ng/mL) was significantly more than in those managed conservatively (0.5-2.0 ng/mL). Using receiver operating characteristic (ROC) curves a cut-off for plasma PCT of >5.0 ng/mL was 75% sensitive and 100% specific for considering surgical intervention in patients presenting with acute abdomen.
  
  
  CONCLUSIONS
  Plasma PCT (value >5 ng/mL) could be used as an adjunct to clinical examination to predict requirement of surgery in patients presenting with acute abdomen.
authors.affiliation: Department of Surgery, St. John's Medical College, Bangalore, India.
authors.forename: Brendan H
authors.identifier: http://orcid.org/0000-0002-8138-5170
authors.initials: BH
authors.lastname: Dias
authors.affiliation: Department of Surgery, St. John's Medical College, Bangalore, India.
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Rozario
authors.affiliation: Department of Surgery, St. John's Medical College, Bangalore, India.
authors.forename: Santosh A
authors.initials: SA
authors.lastname: Olakkengil
mesh_terms: D000006:Abdomen, Acute / Q000097:blood* / Q000188:drug therapy / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000379:methods; D007958:Leukocyte Count / Q000379:methods; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide
keywords: C-reactive protein; CRP; PCT; acute abdomen; procalcitonin