Role of Procalcitonin in Evaluation of the Severity of Acute Cholecystitis.
OBJECTIVE
The aim of this study is to investigate the relationship between procalcitonin (PCT) level and the severity of acute cholecystitis.


METHODS
This study included 200 patients diagnosed with acute cholecystitis. To diagnose and assess the severity of acute cholecystitis; physical examination and abdominal ultrasound findings were evaluated and blood samples were taken to determine white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and levels of coagulation factors, blood gas, C-reactive protein (CRP) and PCT. Patients were classified into three stages, namely, mild, moderate, and severe, according to the severity of acute cholecystitis using the Tokyo guidelines. The role of PCT level in the assessment of severity of acute cholecystitis and the correlation between the stages and PCT level were statistically analyzed.


RESULTS
Among patients with acute cholecystitis, 110 (55%) were classified as mild, 61 (30.5%) as moderate, and 29 (14.5%) as severe. Leukocytosis or leukopenia was positive in 48.5%, ESR elevation was found in 72.5%, CRP positivity in 55.5%, PCT elevation in 27%, and positive findings of ultrasonographic imaging in 54.5% of the patients. Serum WBC count, ESR, and CRP and PCT levels increased as the severity of disease increased (p<0.05). PCT could discriminate grade I from grade II-III with 95.45% sensitivity and 46.67% specificity at the best cut-off value of ≤0.52 (p<0.001). PCT could also discriminate grade III from grade I-II with 72.4% sensitivity and 90.06% specificity at the best cut-off value of >0.8 (p<0.001).


CONCLUSIONS
PCT level may be considered to be a parameter that could be added to the assessment of the severity of acute cholecystitis in the Tokyo guidelines, although further studies are needed to support our findings.
Departmentof Emergency Medicine, Ankara Atatürk Training and Research Hospital, Ankara, Turkey.
Yucel
Y
Yuzbasioglu
Department of Emergency Medicine, Ankara Training and Research Hospital, Ankara, Turkey.
Hikmet
H
Duymaz
Clinic of Emergency Medicine, Konya Training and Research Hospital, Konya, Turkey.
Ceren Sen
CS
Tanrikulu
Clinic of Emergency Medicine, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
Huseyin Cahit
HC
Halhalli
Clinic of Emergency Medicine, Kastamonu State Hospital, Kastamonu, Turkey.
Mirac Ozturk
MO
Koc
Clinic of Emergency Medicine, Keçiören Training and Research Hospital, Ankara, Turkey.
Meral
M
Tandoğan
Department of Emergency Medicine, Kırıkkale University School of Medicine, Kırıkkale, Turkey.
Figen
F
Coskun
Procalcitonin; acute cholecystitis; severity of illness index