Investigating the Diagnostic Value of Serum Calprotectin Level in Patients With Acute Appendicitis
-
Seyed Isaac Hashemy
,
Anvar Soleimani
,
Abolfazl Hekmat Shoar
,
Amin Lotfi
,
Arash Arianpour
,
Aghigh Ziaee Mehr
,
Mohammad Reza Motie
Abstract
Appendicitis is one of the main causes of acute abdominal surgery; however, the accurate diagnosis of appendicitis has remained uncertain. This study aimed to investigate the serum calprotectin as a diagnostic indicator for acute appendicitis. This prospective study was conducted on 79 patients suspected of acute appendicitis who underwent an appendectomy and 70 healthy volunteers. The correlation of serum calprotectin level and histopathological results was investigated. Screening performance characteristics of calprotectin (CP) were calculated on patients suspected with acute appendicitis. The mean serum calprotectin level in the patients was 0.791±0.148 mg/dl with a minimum of 0.567 mg/dl and a maximum of 1.26 mg/dl. The serum calprotectin ranged from 0.10 mg/dl to 0.50 mg/l in the healthy group. The AUC of CP was 0.58 (95% CI: 0.43-0.73). At a 0.72 mg/dl cutoff value, CP had 70% (95% CI: 58-82) sensitivity and 50% (95% CI: 39-61) specificity. According to the main finding of our study, the accuracy and sensitivity of serum CP in the detection of patients with acute appendicitis is good, and it seems that it can be used beside clinical symptoms for the diagnosis of acute appendicitis.
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2. Liang M, Andersson R, Jaffe B, Berger D. The appendix. In: Brunicardi F, Andersen D, Billiar T, Dunn D, Hunter J, Matthews J, et al., editors. Schwartz's Principles of Surgery. 10 ed. New York: McGraw-Hill Professional; 2015:1241-59.
3. Beltran MA, Mendez PE, Barrera RE, Contreras MA, Wilson CS, Cortes VJ, et al. Is hyperbilirubinaemia in appendicitis a better predictor of perforation than C-reactive protein? a prospective study. Indian J Surg 2009;71:265-72.
4. Motie MR, Soleimani A, Soltani A, Hashemy SI. Serum Procalcitonin and Lactoferrin in Detection of Acute Appendicitis; a Diagnostic Accuracy Study. Emerg (Tehran) 2018;6:e51.
5. Thuijls G, Derikx JP, Prakken FJ, Huisman B, van Bijnen Ing AA, van Heurn EL, et al. A pilot study on potential new plasma markers for diagnosis of acute appendicitis. Am J Emerg Med 2011;29:256-60.
6. Sand M, Bechara FG, Holland-Letz T, Sand D, Mehnert G, Mann B. Diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation in acute appendicitis. Am J Surg 2009;198:193-8.
7. Terrin G, Passariello A, Manguso F, Salvia G, Rapacciuolo L, Messina F, et al. Serum calprotectin: an antimicrobial peptide as a new marker for the diagnosis of sepsis in very low birth weight newborns. Clin Dev Immunol 2011;2011: 291085.
8. Fagerhol MK. Calprotectin, a faecal marker of organic gastrointestinal abnormality. Lancet 2000;356:1783-4.
9. Carroll D, Corfield A, Spicer R, Cairns P. Faecal
calprotectin concentrations and diagnosis of necrotising enterocolitis. Lancet 2003;361:310-1.
10. Langhorst J, Elsenbruch S, Koelzer J, Rueffer A, Michalsen A, Dobos GJ. Noninvasive markers in the assessment of intestinal inflammation in inflammatory bowel diseases: performance of fecal lactoferrin, calprotectin, and PMN-elastase, CRP, and clinical indices. Am J Gastroenterol 2008;103:162-9.
11. Brunicardi FC, Andersen DK, Billiar TR, Dunn DL,
Hunter JG, Matthews JB, et al. Schwartz's Principles of Surgery, 10th ed. New York: McGraw-Hill Education; 2014.
12. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986;15:557-64.
13. Pepe MS, Longton G. Standardizing diagnostic markers to evaluate and compare their performance. Epidemiology 2005;16:598-603.
14. Fluss R, Faraggi D, Reiser B. Estimation of the Youden Index and its associated cutoff point. Biom J 2005;47:458-72.
15. Farooqui W, Pommergaard H, Burcharth J, Eriksen J. The diagnostic value of a panel of serological markers in acute appendicitis. Scand J Surg 2015;104:72-8.
16. Paulson EK, Kalady MF, Pappas TN. Suspected appendicitis. N Engl J Med 2003;348:236-42.
17. Mostbeck G, Adam EJ, Nielsen MB, Claudon M, Clevert D, Nicolau C, et al. How to diagnose acute appendicitis: ultrasound first. Insights Imaging 2016;7:255-63.
18. Mikaelsson C, Arnbjornsson E. The value of C-reactive protein (CRP) determinations in patients with suspected acute appendicitis. Ann Chir Gynaecol 1984;73:281-4.
19. Yu CW, Juan LI, Wu MH, Shen CJ, Wu JY, Lee CC. Systematic review and meta-analysis of the diagnostic accuracy of procalcitonin, C-reactive protein and white blood cell count for suspected acute appendicitis. Br J Surg 2013;100:322-9.
20. Bealer JF, Colgin M. S100A8/A9: a potential new diagnostic aid for acute appendicitis. Academic emergency medicine : official journal of the Society for Academic Emerge Medicine. 2010;17(3):333-6.
21. 21. Kharbanda AB, Rai AJ, Cosme Y, Liu K, Dayan PS. Novel serum and urine markers for pediatric appendicitis. Acad Emerg Med 2012;19:56-62.
22. Schellekens DH, Hulsewé KW, Acker BA, Bijnen AA, Jaegere TM, Sastrowijoto SH, et al. Evaluation of the diagnostic accuracy of plasma markers for early diagnosis
in patients suspected for acute appendicitis. Acad Emerg Med 2013;20:703-10.
23. Cikot M, Peker KD, Bozkurt MA, Kocatas A, Kones O, Binboga S, et al. Plasma calprotectin level: usage in distinction of uncomplicated from complicated acute appendicitis. World J Emerg Surg 2016;11:7.
24. Vaos G, Kostakis ID, Zavras N, Chatzemichael A. The role of calprotectin in pediatric disease. BioMed Res Int 2013;2013:542363.
25. Ambe PC, Godde D, Bonicke L, Papadakis M, Storkel S, Zirngibl H. Calprotectin could be a potential biomarker for acute appendicitis. J Transl Med 2016;14:107.
26. Andersson R. Meta‐analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg 2004;91:28-37.
27. Berntzen H, Fagerhol M, Ostensen M, Mowinckel P, Høyeraal H. The L1 protein as a new indicator of inflammatory activity in patients with juvenile rheumatoid arthritis. J Rheumatol 1991;18:133-8.
28. Berntzen HB, Endresen G, Fagerhol M, Spiechowicz J, Mowinckel P. Calprotectin (the LI protein) during surgery in patients with rheumatoid arthritis. Scand J Clin Lab Invest 1991;51:643-50.
29. Brun J, Ulvestad E, Fagerhol M, Jonsson R. Effects of human calprotectin (L1) on in vitro immunoglobulin synthesis. Scand J Immunol 1994;40:675-80.
30. Jangjoo A, Varasteh AR, Bahar MM, Meibodi NT, Aliakbarian M, Hoseininejad M, et al. Is C-reactive protein helpful for early diagnosis of acute appendicitis? Acta Chir Belg 2011;111(4):219-22.
31. Raines A, Garwe T, Wicks R, Palmer M, Wood F, Adeseye A, et al. Pediatric appendicitis: The prevalence of systemic inflammatory response syndrome upon presentation and its association with clinical outcomes. J Pediatr Surg 2013;48:2442-5.
32. Nozoe T, Matsumata T, Sugimachi K. Significance of SIRS score in therapeutic strategy for acute appendicitis. Hepato-gastroenterology 2001;49:444-6.
2. Liang M, Andersson R, Jaffe B, Berger D. The appendix. In: Brunicardi F, Andersen D, Billiar T, Dunn D, Hunter J, Matthews J, et al., editors. Schwartz's Principles of Surgery. 10 ed. New York: McGraw-Hill Professional; 2015:1241-59.
3. Beltran MA, Mendez PE, Barrera RE, Contreras MA, Wilson CS, Cortes VJ, et al. Is hyperbilirubinaemia in appendicitis a better predictor of perforation than C-reactive protein? a prospective study. Indian J Surg 2009;71:265-72.
4. Motie MR, Soleimani A, Soltani A, Hashemy SI. Serum Procalcitonin and Lactoferrin in Detection of Acute Appendicitis; a Diagnostic Accuracy Study. Emerg (Tehran) 2018;6:e51.
5. Thuijls G, Derikx JP, Prakken FJ, Huisman B, van Bijnen Ing AA, van Heurn EL, et al. A pilot study on potential new plasma markers for diagnosis of acute appendicitis. Am J Emerg Med 2011;29:256-60.
6. Sand M, Bechara FG, Holland-Letz T, Sand D, Mehnert G, Mann B. Diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation in acute appendicitis. Am J Surg 2009;198:193-8.
7. Terrin G, Passariello A, Manguso F, Salvia G, Rapacciuolo L, Messina F, et al. Serum calprotectin: an antimicrobial peptide as a new marker for the diagnosis of sepsis in very low birth weight newborns. Clin Dev Immunol 2011;2011: 291085.
8. Fagerhol MK. Calprotectin, a faecal marker of organic gastrointestinal abnormality. Lancet 2000;356:1783-4.
9. Carroll D, Corfield A, Spicer R, Cairns P. Faecal
calprotectin concentrations and diagnosis of necrotising enterocolitis. Lancet 2003;361:310-1.
10. Langhorst J, Elsenbruch S, Koelzer J, Rueffer A, Michalsen A, Dobos GJ. Noninvasive markers in the assessment of intestinal inflammation in inflammatory bowel diseases: performance of fecal lactoferrin, calprotectin, and PMN-elastase, CRP, and clinical indices. Am J Gastroenterol 2008;103:162-9.
11. Brunicardi FC, Andersen DK, Billiar TR, Dunn DL,
Hunter JG, Matthews JB, et al. Schwartz's Principles of Surgery, 10th ed. New York: McGraw-Hill Education; 2014.
12. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986;15:557-64.
13. Pepe MS, Longton G. Standardizing diagnostic markers to evaluate and compare their performance. Epidemiology 2005;16:598-603.
14. Fluss R, Faraggi D, Reiser B. Estimation of the Youden Index and its associated cutoff point. Biom J 2005;47:458-72.
15. Farooqui W, Pommergaard H, Burcharth J, Eriksen J. The diagnostic value of a panel of serological markers in acute appendicitis. Scand J Surg 2015;104:72-8.
16. Paulson EK, Kalady MF, Pappas TN. Suspected appendicitis. N Engl J Med 2003;348:236-42.
17. Mostbeck G, Adam EJ, Nielsen MB, Claudon M, Clevert D, Nicolau C, et al. How to diagnose acute appendicitis: ultrasound first. Insights Imaging 2016;7:255-63.
18. Mikaelsson C, Arnbjornsson E. The value of C-reactive protein (CRP) determinations in patients with suspected acute appendicitis. Ann Chir Gynaecol 1984;73:281-4.
19. Yu CW, Juan LI, Wu MH, Shen CJ, Wu JY, Lee CC. Systematic review and meta-analysis of the diagnostic accuracy of procalcitonin, C-reactive protein and white blood cell count for suspected acute appendicitis. Br J Surg 2013;100:322-9.
20. Bealer JF, Colgin M. S100A8/A9: a potential new diagnostic aid for acute appendicitis. Academic emergency medicine : official journal of the Society for Academic Emerge Medicine. 2010;17(3):333-6.
21. 21. Kharbanda AB, Rai AJ, Cosme Y, Liu K, Dayan PS. Novel serum and urine markers for pediatric appendicitis. Acad Emerg Med 2012;19:56-62.
22. Schellekens DH, Hulsewé KW, Acker BA, Bijnen AA, Jaegere TM, Sastrowijoto SH, et al. Evaluation of the diagnostic accuracy of plasma markers for early diagnosis
in patients suspected for acute appendicitis. Acad Emerg Med 2013;20:703-10.
23. Cikot M, Peker KD, Bozkurt MA, Kocatas A, Kones O, Binboga S, et al. Plasma calprotectin level: usage in distinction of uncomplicated from complicated acute appendicitis. World J Emerg Surg 2016;11:7.
24. Vaos G, Kostakis ID, Zavras N, Chatzemichael A. The role of calprotectin in pediatric disease. BioMed Res Int 2013;2013:542363.
25. Ambe PC, Godde D, Bonicke L, Papadakis M, Storkel S, Zirngibl H. Calprotectin could be a potential biomarker for acute appendicitis. J Transl Med 2016;14:107.
26. Andersson R. Meta‐analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg 2004;91:28-37.
27. Berntzen H, Fagerhol M, Ostensen M, Mowinckel P, Høyeraal H. The L1 protein as a new indicator of inflammatory activity in patients with juvenile rheumatoid arthritis. J Rheumatol 1991;18:133-8.
28. Berntzen HB, Endresen G, Fagerhol M, Spiechowicz J, Mowinckel P. Calprotectin (the LI protein) during surgery in patients with rheumatoid arthritis. Scand J Clin Lab Invest 1991;51:643-50.
29. Brun J, Ulvestad E, Fagerhol M, Jonsson R. Effects of human calprotectin (L1) on in vitro immunoglobulin synthesis. Scand J Immunol 1994;40:675-80.
30. Jangjoo A, Varasteh AR, Bahar MM, Meibodi NT, Aliakbarian M, Hoseininejad M, et al. Is C-reactive protein helpful for early diagnosis of acute appendicitis? Acta Chir Belg 2011;111(4):219-22.
31. Raines A, Garwe T, Wicks R, Palmer M, Wood F, Adeseye A, et al. Pediatric appendicitis: The prevalence of systemic inflammatory response syndrome upon presentation and its association with clinical outcomes. J Pediatr Surg 2013;48:2442-5.
32. Nozoe T, Matsumata T, Sugimachi K. Significance of SIRS score in therapeutic strategy for acute appendicitis. Hepato-gastroenterology 2001;49:444-6.
| Files | ||
| Issue | Vol 57, No 12 (2019) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/acta.v57i12.3466 | |
| Keywords | ||
| Acute appendicitis Calprotectin Diagnosis Accuracy Sensitivity Specificity | ||
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How to Cite
1.
Hashemy SI, Soleimani A, Hekmat Shoar A, Lotfi A, Arianpour A, Ziaee Mehr A, Motie MR. Investigating the Diagnostic Value of Serum Calprotectin Level in Patients With Acute Appendicitis. Acta Med Iran. 2020;57(12):703-708.
