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Biomarkers for Detecting Surgical Emergency in Acute Abdomen-A Prospective Observational Study
Claudine A Blum1,2, Matthieu Faron3,4, Anne Laure Paquet1
1Service d'Accueil des Urgences, GH Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Paris, France.
The Journal of Applied Laboratory Medicine
|November 5, 2025
Summary
In emergency settings, leukocyte and neutrophil cell counts, C-reactive protein (CRP), and procalcitonin show promise for identifying surgical emergencies in patients with acute abdominal pain. Stress biomarkers like copeptin and cortisol were not effective predictors.
Area of Science:
- Emergency Medicine
- Clinical Biochemistry
- Surgical Diagnostics
Background:
- Acute abdominal pain presents a significant diagnostic challenge in emergency settings.
- Identifying surgical emergencies promptly is crucial for patient outcomes.
- Biomarkers may aid in differentiating surgical emergencies from other causes of abdominal pain.
Purpose of the Study:
- To evaluate the diagnostic value of inflammatory and stress biomarkers in identifying surgical emergencies among patients with acute abdominal pain.
- To compare the predictive performance of various biomarkers, including copeptin, cortisol, procalcitonin, IL-6, CRP, and cell counts.
Main Methods:
- Prospective observational study of 304 patients presenting to the emergency department with acute abdominal pain.
- Measurement of copeptin, cortisol, procalcitonin, IL-6, CRP, leukocyte, and neutrophil cell counts upon presentation and at 4 hours.
- Telephone follow-up at 2 weeks to determine diagnosis and outcomes.
Main Results:
- Surgical emergencies were identified in 46 (15%) patients.
- Leukocyte and neutrophil cell counts demonstrated good predictive value (AUC 0.75) for surgical emergencies.
- C-reactive protein (CRP) and procalcitonin showed mediocre performance, while IL-6, copeptin, and cortisol were not useful predictors.
- A recursive partitioning model identified CRP as the most relevant biomarker for predicting surgical emergency.
Conclusions:
- Stress biomarkers copeptin and cortisol are not effective for identifying surgical emergencies.
- Initial leukocyte and neutrophil cell counts, CRP, and procalcitonin are valuable for identifying surgical emergencies in acute abdomen.
- Interleukin-6 (IL-6) measured at 4 hours also showed potential utility in identifying surgical emergencies.
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