Background. To our knowledge, the predictive value of procalcitonin for
bowel strangulation has been evaluated in only 2 experimental studies
that had conflicting results. The objective of this study was to
evaluate the value of procalcitonin for early diagnosis of intestinal
ischemia and necrosis in acute bowel obstruction.
Methods. We performed a prospective study of 242 patients with small- or
large-bowel obstructions in 2005. A total of 100 patients who underwent
operation. were divided into groups according to the presence of
ischemia (reversible and irreversible) and necrosis, respectively, as
follows: ischemia (n = 35) and nonischemia groups (n = 65) and necrosis
(n = 22) and nonnecrosis groups (n = 78). Data analyzed included age,
sex, vital signs, symptoms, clinical findings, white blood cell count,
base deficit,. metabolic acidosis, procalcitonin levels on presentation,
the time between symptom onset and arrival at the emergency department
and the time between arrival and operation, and the cause of the
obstruction.
Results. Procalcitonin levels were greater in the ischemia than the
nonischemia group (9.62 vs 0.30 ng/mL; P = .0001) and in the necrosis
than the non-necrosis group (14.53 vs 0.32 ng/mL; P = .0001).
Multivariate analysis identified procalcitonin as an independent
predictor of ischemia (P = .009; odds ratio, 2.252; 95% confidence
interval, 1.225-4.140) and necrosis (P = .005; odds ratio, 2.762; 95%
confidence interval, 1.356-5.627). Using receiver operating
characteristic (ROC) curve analysis, the area under the curve (AUC) of
procalcitonin for ischemia and necrosis was 0.77 and 0.87, respectively.
A high negative predictive value for ischemia and necrosis of
procalcitonin levels < 0.25 ng/mL (83% and 95%, respectively) and a
positive predictive value of procalcitonin > 1 ng/mL were identified
(95% and 90%, respectively).
Conclusion. Procalcitonin on presentation is very useful for the
diagnosis or exclusion of intestinal ischemia and necrosis in acute
bowel obstruction and could serve as an additional diagnostic tool to
improve clinical decision-making. (Surgery 2011;149:394-403.
