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Abstract
The aim of this study is to investigate the relationship between procalcitonin (PCT) level and the severity of acute cholecystitis. 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. 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). 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.
Highlights
Acute cholecystitis (AC) is one of the important causes of abdominal pain on presentation to the emergency department
Leukocytosis or leukopenia was positive in 48.5%, erythrocyte sedimentation rate (ESR) elevation was found in 72.5%, C-reactive protein (CRP) positivity in 55.5%, PCT elevation in 27%, and positive findings of ultrasonographic imaging in 54.5% of the patients
Serum white blood cell (WBC) count, ESR, and CRP and PCT levels increased as the severity of disease increased (p
Summary
Diagnosis and treatment of AC has a positive effect on morbidity and mortality [1, 2]. Acute cholecystitis is usually diagnosed based on the presence of non-characteristic local and/ or systemic inflammatory findings and/or the result of ultrasonographic examination [1,2,3]. Yuzbasioglu et al Procalcitonin in Acute Cholecystitis 163. The levels of leukocytosis and C-reactive protein (CRP) were assessed for predicting the severity of AC, but neither was found to be useful [1,2,3,4,5]. Procalcitonin (PCT) was shown to increase in the first hours after systemic inflammation and peaked earlier than CRP did in the plasma [5]
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