Predictive value of procalcitonin for bowel ischemia and necrosis in bowel obstruction

Haridimos Markogiannakis, Nikolaos Memos, Evangelos Messaris, Dimitrios Dardamanis, Andreas Larentzakis, Dimitrios Papanikolaou, George C. Zografos, Andreas Manouras

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background: To our knowledge, the predictive value of procalcitonin for bowel strangulation has been evaluated in only 2 experimental studies that had conflicting results. The objective of this study was to evaluate the value of procalcitonin for early diagnosis of intestinal ischemia and necrosis in acute bowel obstruction. Methods: We performed a prospective study of 242 patients with small- or large-bowel obstructions in 2005. A total of 100 patients who underwent operation were divided into groups according to the presence of ischemia (reversible and irreversible) and necrosis, respectively, as follows: ischemia (n = 35) and nonischemia groups (n = 65) and necrosis (n = 22) and nonnecrosis groups (n = 78). Data analyzed included age, sex, vital signs, symptoms, clinical findings, white blood cell count, base deficit, metabolic acidosis, procalcitonin levels on presentation, the time between symptom onset and arrival at the emergency department and the time between arrival and operation, and the cause of the obstruction. Results: Procalcitonin levels were greater in the ischemia than the nonischemia group (9.62 vs 0.30 ng/mL; P = .0001) and in the necrosis than the non-necrosis group (14.53 vs 0.32 ng/mL; P = .0001). Multivariate analysis identified procalcitonin as an independent predictor of ischemia (P = .009; odds ratio, 2.252; 95% confidence interval, 1.225-4.140) and necrosis (P = .005; odds ratio, 2.762; 95% confidence interval, 1.356-5.627). Using receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) of procalcitonin for ischemia and necrosis was 0.77 and 0.87, respectively. A high negative predictive value for ischemia and necrosis of procalcitonin levels <0.25 ng/mL (83% and 95%, respectively) and a positive predictive value of procalcitonin >1 ng/mL were identified (95% and 90%, respectively). Conclusion: Procalcitonin on presentation is very useful for the diagnosis or exclusion of intestinal ischemia and necrosis in acute bowel obstruction and could serve as an additional diagnostic tool to improve clinical decision-making.

Original languageEnglish (US)
Pages (from-to)394-403
Number of pages10
JournalSurgery
Volume149
Issue number3
DOIs
StatePublished - Mar 1 2011

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Calcitonin
Necrosis
Ischemia
Odds Ratio
Confidence Intervals
Vital Signs
Acidosis
Leukocyte Count
ROC Curve
Signs and Symptoms
Area Under Curve
Hospital Emergency Service
Early Diagnosis
Multivariate Analysis
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Markogiannakis, H., Memos, N., Messaris, E., Dardamanis, D., Larentzakis, A., Papanikolaou, D., ... Manouras, A. (2011). Predictive value of procalcitonin for bowel ischemia and necrosis in bowel obstruction. Surgery, 149(3), 394-403. https://doi.org/10.1016/j.surg.2010.08.007
Markogiannakis, Haridimos ; Memos, Nikolaos ; Messaris, Evangelos ; Dardamanis, Dimitrios ; Larentzakis, Andreas ; Papanikolaou, Dimitrios ; Zografos, George C. ; Manouras, Andreas. / Predictive value of procalcitonin for bowel ischemia and necrosis in bowel obstruction. In: Surgery. 2011 ; Vol. 149, No. 3. pp. 394-403.
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title = "Predictive value of procalcitonin for bowel ischemia and necrosis in bowel obstruction",
abstract = "Background: To our knowledge, the predictive value of procalcitonin for bowel strangulation has been evaluated in only 2 experimental studies that had conflicting results. The objective of this study was to evaluate the value of procalcitonin for early diagnosis of intestinal ischemia and necrosis in acute bowel obstruction. Methods: We performed a prospective study of 242 patients with small- or large-bowel obstructions in 2005. A total of 100 patients who underwent operation were divided into groups according to the presence of ischemia (reversible and irreversible) and necrosis, respectively, as follows: ischemia (n = 35) and nonischemia groups (n = 65) and necrosis (n = 22) and nonnecrosis groups (n = 78). Data analyzed included age, sex, vital signs, symptoms, clinical findings, white blood cell count, base deficit, metabolic acidosis, procalcitonin levels on presentation, the time between symptom onset and arrival at the emergency department and the time between arrival and operation, and the cause of the obstruction. Results: Procalcitonin levels were greater in the ischemia than the nonischemia group (9.62 vs 0.30 ng/mL; P = .0001) and in the necrosis than the non-necrosis group (14.53 vs 0.32 ng/mL; P = .0001). Multivariate analysis identified procalcitonin as an independent predictor of ischemia (P = .009; odds ratio, 2.252; 95{\%} confidence interval, 1.225-4.140) and necrosis (P = .005; odds ratio, 2.762; 95{\%} confidence interval, 1.356-5.627). Using receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) of procalcitonin for ischemia and necrosis was 0.77 and 0.87, respectively. A high negative predictive value for ischemia and necrosis of procalcitonin levels <0.25 ng/mL (83{\%} and 95{\%}, respectively) and a positive predictive value of procalcitonin >1 ng/mL were identified (95{\%} and 90{\%}, respectively). Conclusion: Procalcitonin on presentation is very useful for the diagnosis or exclusion of intestinal ischemia and necrosis in acute bowel obstruction and could serve as an additional diagnostic tool to improve clinical decision-making.",
author = "Haridimos Markogiannakis and Nikolaos Memos and Evangelos Messaris and Dimitrios Dardamanis and Andreas Larentzakis and Dimitrios Papanikolaou and Zografos, {George C.} and Andreas Manouras",
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Markogiannakis, H, Memos, N, Messaris, E, Dardamanis, D, Larentzakis, A, Papanikolaou, D, Zografos, GC & Manouras, A 2011, 'Predictive value of procalcitonin for bowel ischemia and necrosis in bowel obstruction', Surgery, vol. 149, no. 3, pp. 394-403. https://doi.org/10.1016/j.surg.2010.08.007

Predictive value of procalcitonin for bowel ischemia and necrosis in bowel obstruction. / Markogiannakis, Haridimos; Memos, Nikolaos; Messaris, Evangelos; Dardamanis, Dimitrios; Larentzakis, Andreas; Papanikolaou, Dimitrios; Zografos, George C.; Manouras, Andreas.

In: Surgery, Vol. 149, No. 3, 01.03.2011, p. 394-403.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Predictive value of procalcitonin for bowel ischemia and necrosis in bowel obstruction

AU - Markogiannakis, Haridimos

AU - Memos, Nikolaos

AU - Messaris, Evangelos

AU - Dardamanis, Dimitrios

AU - Larentzakis, Andreas

AU - Papanikolaou, Dimitrios

AU - Zografos, George C.

AU - Manouras, Andreas

PY - 2011/3/1

Y1 - 2011/3/1

N2 - Background: To our knowledge, the predictive value of procalcitonin for bowel strangulation has been evaluated in only 2 experimental studies that had conflicting results. The objective of this study was to evaluate the value of procalcitonin for early diagnosis of intestinal ischemia and necrosis in acute bowel obstruction. Methods: We performed a prospective study of 242 patients with small- or large-bowel obstructions in 2005. A total of 100 patients who underwent operation were divided into groups according to the presence of ischemia (reversible and irreversible) and necrosis, respectively, as follows: ischemia (n = 35) and nonischemia groups (n = 65) and necrosis (n = 22) and nonnecrosis groups (n = 78). Data analyzed included age, sex, vital signs, symptoms, clinical findings, white blood cell count, base deficit, metabolic acidosis, procalcitonin levels on presentation, the time between symptom onset and arrival at the emergency department and the time between arrival and operation, and the cause of the obstruction. Results: Procalcitonin levels were greater in the ischemia than the nonischemia group (9.62 vs 0.30 ng/mL; P = .0001) and in the necrosis than the non-necrosis group (14.53 vs 0.32 ng/mL; P = .0001). Multivariate analysis identified procalcitonin as an independent predictor of ischemia (P = .009; odds ratio, 2.252; 95% confidence interval, 1.225-4.140) and necrosis (P = .005; odds ratio, 2.762; 95% confidence interval, 1.356-5.627). Using receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) of procalcitonin for ischemia and necrosis was 0.77 and 0.87, respectively. A high negative predictive value for ischemia and necrosis of procalcitonin levels <0.25 ng/mL (83% and 95%, respectively) and a positive predictive value of procalcitonin >1 ng/mL were identified (95% and 90%, respectively). Conclusion: Procalcitonin on presentation is very useful for the diagnosis or exclusion of intestinal ischemia and necrosis in acute bowel obstruction and could serve as an additional diagnostic tool to improve clinical decision-making.

AB - Background: To our knowledge, the predictive value of procalcitonin for bowel strangulation has been evaluated in only 2 experimental studies that had conflicting results. The objective of this study was to evaluate the value of procalcitonin for early diagnosis of intestinal ischemia and necrosis in acute bowel obstruction. Methods: We performed a prospective study of 242 patients with small- or large-bowel obstructions in 2005. A total of 100 patients who underwent operation were divided into groups according to the presence of ischemia (reversible and irreversible) and necrosis, respectively, as follows: ischemia (n = 35) and nonischemia groups (n = 65) and necrosis (n = 22) and nonnecrosis groups (n = 78). Data analyzed included age, sex, vital signs, symptoms, clinical findings, white blood cell count, base deficit, metabolic acidosis, procalcitonin levels on presentation, the time between symptom onset and arrival at the emergency department and the time between arrival and operation, and the cause of the obstruction. Results: Procalcitonin levels were greater in the ischemia than the nonischemia group (9.62 vs 0.30 ng/mL; P = .0001) and in the necrosis than the non-necrosis group (14.53 vs 0.32 ng/mL; P = .0001). Multivariate analysis identified procalcitonin as an independent predictor of ischemia (P = .009; odds ratio, 2.252; 95% confidence interval, 1.225-4.140) and necrosis (P = .005; odds ratio, 2.762; 95% confidence interval, 1.356-5.627). Using receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) of procalcitonin for ischemia and necrosis was 0.77 and 0.87, respectively. A high negative predictive value for ischemia and necrosis of procalcitonin levels <0.25 ng/mL (83% and 95%, respectively) and a positive predictive value of procalcitonin >1 ng/mL were identified (95% and 90%, respectively). Conclusion: Procalcitonin on presentation is very useful for the diagnosis or exclusion of intestinal ischemia and necrosis in acute bowel obstruction and could serve as an additional diagnostic tool to improve clinical decision-making.

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Markogiannakis H, Memos N, Messaris E, Dardamanis D, Larentzakis A, Papanikolaou D et al. Predictive value of procalcitonin for bowel ischemia and necrosis in bowel obstruction. Surgery. 2011 Mar 1;149(3):394-403. https://doi.org/10.1016/j.surg.2010.08.007