The Use of Procalcitonin in the Diagnosis of Acute Appendicitis: A Systematic Review

Abstract

Background: Acute appendicitis (AA) is one of the most common surgical pathologies. Its diagnosis is often carried out based on clinical signs and symptoms, with additional minimally invasive tests (i.e., blood testing) done to support the diagnosis. Procalcitonin (PCT) is a relatively novel biomarker that is starting to be used by clinicians for patients admitted into hospitals with a variety of infections. Its level can be used to identify the presence of infection. The aim of this review is to assess how useful PCT is as a biomarker in supporting clinicians' assessment of patients with suspected appendicitis.

Methods: A systematic literature search was carried out, yielding a total of 16 primary research papers deemed appropriate for appraisal.

Results: The usefulness of PCT in aiding the diagnosis of AA depends on the severity of appendicitis. Patients who experience complicated appendicitis (CAA) such as perforation, gangrene, or necrosis have a significantly raised PCT level (p<0.05) compared to those with uncomplicated appendicitis (UAA) and a variety of other non-appendiceal intra-abdominal pathologies.

Conclusions: The use of PCT in UAA is weak, however, PCT was deemed useful in helping predict CAA, thus helping portray the severity of infection. This, in turn, will help ensure patients are taken to the operating theatre in a timely and safe manner for subsequent appendicectomy.

Keywords: appendix histopathology; biochemical marker; complicated appendicitis; procalcitonin; uncomplicated appendicitis.

Figure 1. Inflamed appendix on laparoscopy

Joseph CT, Tsang CLN, Goltsman D, Garibotto NL, Mekisic A. Synchronous Acute Appendicitis and Cholecystitis in a Paediatric Patient with Salmonella Enteritis. Cureus. 2020;12(3). doi:10.7759/CUREUS.7214

Figure 2. Axial, non-contrast CT scan showing acute appendicitis. Blue arrow shows a calcified deposit within the appendix.

Ali M, Iqbal J, Sayani R. Accuracy of Computed Tomography in Differentiating Perforated from Nonperforated Appendicitis, Taking Histopathology as the Gold Standard. Cureus. 2018;10(12). doi:10.7759/CUREUS.3735

Figure 3. PRISMA flow chart

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339(7716):332-336. doi:10.1136/BMJ.B2535