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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.
Background:
In the emergency setting, acute abdominal pain is a diagnostic challenge. We evaluated the diagnostic value of selected inflammatory and stress biomarkers to identify surgical emergency.
Methods:
Patients presenting to the emergency department (ED) with acute abdominal pain were included in this prospective observational study. Copeptin, cortisol, procalcitonin, and interleukin 6 (IL-6) were measured upon presentation and at 4 h, in addition to C-reactive protein (CRP), and leukocyte and neutrophil cell counts. At 2 weeks, follow-up was performed by telephone interview.
Results:
Of the 304 patients included, 46 (15%) patients had a surgical emergency and 87 (29%) a medical emergency. On admission, CRP, procalcitonin, and leukocyte and neutrophil cell counts were higher in patients with a surgical emergency (P = 0.024, P = 0.009, P = 0.0032, and P < 0.0001, respectively) and medical emergency (all P < 0.001) as compared to patients without emergency. Area under the receiver operating characteristic curve (AUC) was to predict surgical emergency and were good for leukocyte (AUC 0.75, 95% CI, 0.66-0.84) and neutrophil cell count (AUC 0.75, 95%, CI 0.66-0.84), mediocre for CRP (AUC 0.64, 95% CI, 0.55-0.73) and procalcitonin (AUC 0.62, 95%CI 0.45-0.75), and not useful for IL-6, copeptin, or cortisol. A recursive partitioning prediction model yielded CRP as the most relevant biomarker to predict surgical emergency.
Conclusions:
The stress biomarkers copeptin and cortisol were not useful for identifying surgical emergency. Among the tested biomarkers, initial leukocyte and neutrophil cell counts, CRP and procalcitonin, and IL-6 at Hour 4, performed similarly to identify surgical emergency in acute abdomen.
Clinicaltrials.Gov Registration Number:
NCT02399150.
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