Procalcitonin as a predictive value for intestinal ischemia and necrosis in acute intestinal obstruction patients underwent urgent operation

OBJECTIVE: To assess the value of procalcitonin for early detection of intestinal ischemia and necrosis in patients suffering from acute intestinal obstruction on presentation at emergency department before urgent operation. METHODS PATIENTS AND: This was a prospective study of 80 patients who suffering from acute intestinal obstruction and underwent urgent operation in emergency department of Aswan University Hospital. This 80 patients were divided into two groups. Group A (non-ischemia group, n=28). Group B (ischemia group, n=52), this group was divided into two subgroups (B1and B2). B1 (32 patients) was considered as reversible ischemia group and B2 (20 patients) was considered as irreversible ischemia group. Group A and subgroup B1 (60 patients) was considered as non-necrosis group but subgroup B2 (20 patients) was considered as necrosis group. Group C (20 patients) was considered as control group. The important analyzed data included age, sex, special habits, the time between symptom onset and arrival at the emergency department, vital signs, symptoms, clinical findings, white blood cells count, base deficit, metabolic acidosis, serum procalcitonin levels on presentation at emergency department, the time between arrival and operation, operative findings and what’s done, post-operative complications and outcome. RESULTS: Serum Procalcitonin level shows insignificant deference between control and non-ischemia groups 0.33 vs 0.47 ng/ml (P= 0.15). But there was significant increase in the serum procalcitonin levels in ischemia than non-ischemia groups 4.40 vs 0.47 ng/ml (P = <0.0001) and in necrosis than non-necrosis groups 9.46 vs 0.88 ng/ml (P = <0.0001). Multivariate analysis identified serum procalcitonin as an independent predictor of intestinal ischemia in acute intestinal obstruction (P = 0.001, odds ratio 7.17, 95%. confidence interval 2.31-22.21) and necrosis (P = 0.002, odds ratio 1.71, confidence interval 1.21- 2.42). Using receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) of serum procalcitonin for intestinal ischemia and necrosis was 0.85 and 0.81 respectively. A high negative predictive value (NPV) for intestinal ischemia and necrosis of serum procalcitonin levels at <0.36 ng/ml (cut off point) was 80% and 90% respectively. Also a positive predictive value (PPV) for intestinal ischemia and necrosis of serum procalcitonin at >1.77ng/ml were 92% and 70% respectively. CONCLUSION: Serum procalcitonin levels on presentation at emergency department were an independent predictor of intestinal ischemia and necrosis. Thus procalcitonin may be useful for early detection or exclusion of intestinal ischemia and necrosis in acute intestinal obstruction and can be used as an additional diagnostic tool to improve clinical decision-making.