Procalcitonin and inflammatory biomarkers in tubo-ovarian abscess: Predicting surgical intervention

Pelvic inflammatory disease (PID) and tubo-ovarian abscess (TOA) are significant gynecological infections that can lead to serious complications such as infertility and chronic pelvic pain. This study aimed to evaluate the diagnostic and prognostic value of procalcitonin (PCT) and other inflammatory biomarkers (C-reactive protein [CRP], white blood cell count [WBC], and neutrophil-to-lymphocyte ratio [NLR]) in patients with PID and TOA, and to identify predictors of treatment failure.

A retrospective cohort study was conducted on 136 patients diagnosed with PID or TOA at Prof. Dr. Cemil Taşçıoğlu City Hospital between January 2021 and December 2023. Demographic data, clinical findings, and laboratory results (PCT, CRP, WBC, NLR) were collected. Statistical analyses were performed using the Number Cruncher Statistical System (NCSS) 2007 software.

Of the 136 patients, 103 (75.73%) were diagnosed with TOA and 33 (24.26%) with PID without TOA. The TOA group had significantly longer hospital stays and higher levels of PCT, CRP, WBC, and NLR compared to the PID group (p<0.05). Multivariate analysis identified CRP as the most significant predictor of TOA (p=0.03). Among TOA patients, 53.3% required surgical intervention. Patients who underwent surgery had significantly higher PCT and NLR levels (p<0.05). Receiver operating characteristic (ROC) analysis showed that a PCT cut-off value of 0.21 ng/mL predicted the need for surgical treatment with a sensitivity of 69.09% and specificity of 64.58%.

Procalcitonin and neutrophil-to-lymphocyte ratio are valuable biomarkers in the diagnosis and management of TOA. Elevated PCT and NLR levels are associated with an increased likelihood of surgical intervention. Together with abscess size, these biomarkers can help predict treatment failure and support clinical decision-making. However, further prospective multicenter studies are necessary to validate these findings.