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Evaluation of the Diagnostic Accuracy of Plasma Markers for Early Diagnosis in Patients Suspected for Acute Appendicitis
Objectives The main objective of this study was to evaluate the diagnostic accuracy of two novel biomarkers, calprotectin (CP) and serum amyloid A (SAA), along with the more traditional inflammatory markers C‐reactive protein (CRP) and white blood cell count (WBC), in patients suspected of having ac...
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| Published in: | Academic emergency medicine 2013-07, Vol.20 (7), p.703-710 |
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| container_title | Academic emergency medicine |
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| creator | Schellekens, Dirk H. S. M. Hulsewé, Karel W. E. Acker, Bernadette A. C. Bijnen, Annemarie A. Jaegere, Tom M. H. Sastrowijoto, Suprapto H. Buurman, Wim A. Derikx, Joep P. M. Lewis, Lawrence |
| description | Objectives
The main objective of this study was to evaluate the diagnostic accuracy of two novel biomarkers, calprotectin (CP) and serum amyloid A (SAA), along with the more traditional inflammatory markers C‐reactive protein (CRP) and white blood cell count (WBC), in patients suspected of having acute appendicitis (AA). The secondary objective was to compare diagnostic accuracy of these biomarkers with a clinical scoring system and radiologic imaging.
Methods
A total of 233 patients with suspected AA, presenting to the emergency department (ED) between January 2010 and September 2010, and 52 healthy individuals serving as controls, were included in the study. Blood was drawn and CP and SAA−1 concentrations were measured using enzyme‐linked immunosorbent assay (ELISA). CRP and WBC concentrations were routinely measured and retrospectively ed from the electronic health record, together with physical examination findings and radiologic reports. The Alvarado score was calculated as a clinical scoring system for AA. Final diagnosis of AA was based on histopathologic examination. The Mann‐Whitney U‐test was used for between‐group comparisons. Receiver operating characteristic (ROC) curves were used to measure the diagnostic accuracy for the tests and to determine the best cutoff points.
Results
Seventy‐seven of 233 patients (33%) had proven AA. Median plasma levels for CP and SAA−1 were significantly higher in patients with AA than in those with another final diagnosis (CP, 320.9 ng/mL vs. 212.9 ng/mL; SAA−1, 30 mg/mL vs. 0.6 mg/mL; p |
| doi_str_mv | 10.1111/acem.12160 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1401090098</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1401090098</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3930-1844b5434e8092c798ce4a2150616cade0c2063921d97983119970936c99fb013</originalsourceid><addsrcrecordid>eNp90ctO3DAUBmCrKmJgyqYPUFnqpkIKnGPn5mU0DG0lECMV1pHHOQHT3LCT0nl7PAywYIE3tnQ-_7b0M_YV4QTDOtWG2hMUmMIndoBJIiORofgczpCqKE1SOWOH3t8DQJKpbJ_NhMwTleTxAfu__KebSY-273hf8_GO-JnVt13vR2t4YczktNlsR6tG-1bzS-3-kvO87h1fatdsXr313HZ8FaKoGz3_M_mBzEjVsyzMNBIvhoG6yho7Wv-F7dW68XT0ss_ZzfnyevErurj6-XtRXERGKgkR5nG8TmIZUw5KmEzlhmItMIEUU6MrAiMglUpgpcJQIiqVgZKpUapeA8o5-7HLHVz_MJEfy9Z6Q02jO-onX2IMCAog3J2z7-_ofT-5LvwuKBR5eBGyoI53yrjee0d1OTjbarcpEcptH-W2j_K5j4C_vURO65aqN_paQAC4A4-2oc0HUWWxWF7uQp8AjpGTcQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1412861607</pqid></control><display><type>article</type><title>Evaluation of the Diagnostic Accuracy of Plasma Markers for Early Diagnosis in Patients Suspected for Acute Appendicitis</title><source>Wiley</source><creator>Schellekens, Dirk H. S. M. ; Hulsewé, Karel W. E. ; Acker, Bernadette A. C. ; Bijnen, Annemarie A. ; Jaegere, Tom M. H. ; Sastrowijoto, Suprapto H. ; Buurman, Wim A. ; Derikx, Joep P. M. ; Lewis, Lawrence</creator><contributor>Lewis, Lawrence</contributor><creatorcontrib>Schellekens, Dirk H. S. M. ; Hulsewé, Karel W. E. ; Acker, Bernadette A. C. ; Bijnen, Annemarie A. ; Jaegere, Tom M. H. ; Sastrowijoto, Suprapto H. ; Buurman, Wim A. ; Derikx, Joep P. M. ; Lewis, Lawrence ; Lewis, Lawrence</creatorcontrib><description><![CDATA[Objectives
The main objective of this study was to evaluate the diagnostic accuracy of two novel biomarkers, calprotectin (CP) and serum amyloid A (SAA), along with the more traditional inflammatory markers C‐reactive protein (CRP) and white blood cell count (WBC), in patients suspected of having acute appendicitis (AA). The secondary objective was to compare diagnostic accuracy of these biomarkers with a clinical scoring system and radiologic imaging.
Methods
A total of 233 patients with suspected AA, presenting to the emergency department (ED) between January 2010 and September 2010, and 52 healthy individuals serving as controls, were included in the study. Blood was drawn and CP and SAA−1 concentrations were measured using enzyme‐linked immunosorbent assay (ELISA). CRP and WBC concentrations were routinely measured and retrospectively ed from the electronic health record, together with physical examination findings and radiologic reports. The Alvarado score was calculated as a clinical scoring system for AA. Final diagnosis of AA was based on histopathologic examination. The Mann‐Whitney U‐test was used for between‐group comparisons. Receiver operating characteristic (ROC) curves were used to measure the diagnostic accuracy for the tests and to determine the best cutoff points.
Results
Seventy‐seven of 233 patients (33%) had proven AA. Median plasma levels for CP and SAA−1 were significantly higher in patients with AA than in those with another final diagnosis (CP, 320.9 ng/mL vs. 212.9 ng/mL; SAA−1, 30 mg/mL vs. 0.6 mg/mL; p < 0.001). CRP and WBC were significantly higher in patients with AA as well. The Alvarado score was helpful at the extremes (<3 or >7). Ultrasound (US) had a sensitivity of 84% and a specificity of 94%. Computed tomography (CT) had a sensitivity of 100% and a specificity of 91%. The area under the ROC (95% confidence interval [CI]) was 0.67 (95% CI = 0.60 to 0.74) for CP, 0.76 (95% CI = 0.70 to 0.82) for SAA, 0.71 (95% CI = 0.64 to 0.78) for CRP, and 0.79 (95% CI = 0.73 to 0.85) for WBC. No cutoff points had high enough sensitivity and specificity to accurately diagnose AA. However, a high sensitivity of 97% was shown at 7.5 × 109/L for WBC and 0.375 mg/mL for SAA.
Conclusions
CP, SAA−1, CRP, and WBC were significantly elevated in patients with AA. None had cutoff points that could accurately discriminate between AA and other pathology in patients with suspected AA. A WBC < 7.5 × 109/L, with a low level of clinical suspicion for AA, can identify a subgroup of patients who may be sent home without further evaluation, but who should have available next‐day follow‐up.
Resumen
Evaluación de la Certeza Diagnóstica de Marcadores Plasmáticos para el Diagnóstico Precoz en los Pacientes con Sospecha de Apendicitis Aguda
Objetivos
El principal objetivo de este estudio fue evaluar la certeza diagnóstica en los pacientes con sospecha de tener una apendicitis aguda de dos nuevos biomarcadores, la calprotectina (CP) y el amiloide A sérico (AAS), junto con los marcadores inflamatorios más tradicionales, como la proteína C reactiva (PCR) y el número de leucocitos. El objetivo secundario fue comparar la certeza diagnóstica de estos biomarcadores con un sistema de puntuación clínica y la imagen radiológica.
Metodología
Se incluyeron en este estudio 233 pacientes con sospecha de apendicitis que acudieron al servicio de urgencias (SU) entre enero de 2010 y septiembre de 2010, y 52 individuos sanos que sirvieron como controles. Se extrajo sangre y se midió la CP y el AAS mediante un ELISA. La PCR y el número de leucocitos se midieron de forma rutinaria y se recogieron de forma retrospectiva de las historias clínicas electrónicas, junto con los hallazgos de la exploración física y los informes radiológicos. La escala Alvarado (Alvarado score) se calculó como un sistema de puntuación clínica para la apendicitis aguda. El diagnóstico final de apendicitis aguda se basó en el examen histopatológico. Se utilizó el test de la U de Mann‐Whitney para la comparación entre los grupos. Las curvas ROC se utilizaron para medir la certeza diagnóstica de las pruebas diagnósticas y para determinar los mejores puntos de corte.
Resultados
Setenta y siete de 233 pacientes (33%) tuvieron apendicitis aguda con certeza. Las medianas de los niveles plasmáticos de CP y AAS fueron significativamente más altas en los pacientes con apendicitis aguda que en aquellos con otro diagnóstico final (CP 321 ng/mL vs. 213 ng/mL; AAS 30 mg/mL vs. 0,6 mg/mL; p < 0,001). La PCR y los leucocitos estaban también significativamente más elevados en los pacientes con apendicitis aguda. La escala de Alvarado fue de ayuda en los extremos (< 3 o > 7). La ecografía tuvo una sensibilidad de un 84% y una especificidad de un 94%. La tomografía computarizada (TC) tuvo una sensibilidad de un 100% y una especificidad de un 91%. La curva ROC (intervalo de confianza 95%) fue de 0,67 (IC 95% = 0,60 a 0,74) para la CP, de 0,76 (IC 95% = 0,70 a 0,82) para la AAS, de 0,71 (IC 95%= 0,64 a 0,78) para la PCR y de 0,79 (IC 95%= 0,73 a 0,85) para los leucocitos.
Conclusiones
La CP, la AAS, la PCR y el número de leucocitos estaban significativamente elevados en los pacientes con apendicitis aguda. No hay un punto de corte que pueda discriminar de forma certera entre la apendicitis aguda y otra patología en los pacientes con sospecha de apendicitis aguda. Un número de leucocitos < 7,5 × 109/L, con un bajo nivel de sospecha clínica para la apendicitis aguda, puede identificar un subgrupo de pacientes que puede ser enviado a casa sin más evaluaciones, aunque estos pacientes deberían disponer de un seguimiento al día siguiente.]]></description><identifier>ISSN: 1069-6563</identifier><identifier>EISSN: 1553-2712</identifier><identifier>DOI: 10.1111/acem.12160</identifier><identifier>PMID: 23859584</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Adolescent ; Adult ; Aged ; Appendectomy - methods ; Appendicitis ; Appendicitis - blood ; Appendicitis - diagnosis ; Appendicitis - surgery ; Biomarkers ; Biomarkers - blood ; C-Reactive Protein - metabolism ; Case-Control Studies ; Child ; Child, Preschool ; Confidence Intervals ; Early Diagnosis ; Emergency medical care ; Emergency Service, Hospital ; Enzyme-Linked Immunosorbent Assay ; Female ; Follow-Up Studies ; Humans ; Leukocyte Count ; Leukocyte L1 Antigen Complex - blood ; Leukocytes ; Male ; Middle Aged ; Proteins ; Radiology ; ROC Curve ; Sensitivity and Specificity ; Serum Amyloid A Protein - metabolism ; Severity of Illness Index ; Statistics, Nonparametric ; Treatment Outcome ; Young Adult</subject><ispartof>Academic emergency medicine, 2013-07, Vol.20 (7), p.703-710</ispartof><rights>2013 by the Society for Academic Emergency Medicine</rights><rights>2013 by the Society for Academic Emergency Medicine.</rights><rights>Copyright Hanley & Belfus, Inc. Jul 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3930-1844b5434e8092c798ce4a2150616cade0c2063921d97983119970936c99fb013</citedby><cites>FETCH-LOGICAL-c3930-1844b5434e8092c798ce4a2150616cade0c2063921d97983119970936c99fb013</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23859584$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Lewis, Lawrence</contributor><creatorcontrib>Schellekens, Dirk H. S. M.</creatorcontrib><creatorcontrib>Hulsewé, Karel W. E.</creatorcontrib><creatorcontrib>Acker, Bernadette A. C.</creatorcontrib><creatorcontrib>Bijnen, Annemarie A.</creatorcontrib><creatorcontrib>Jaegere, Tom M. H.</creatorcontrib><creatorcontrib>Sastrowijoto, Suprapto H.</creatorcontrib><creatorcontrib>Buurman, Wim A.</creatorcontrib><creatorcontrib>Derikx, Joep P. M.</creatorcontrib><creatorcontrib>Lewis, Lawrence</creatorcontrib><title>Evaluation of the Diagnostic Accuracy of Plasma Markers for Early Diagnosis in Patients Suspected for Acute Appendicitis</title><title>Academic emergency medicine</title><addtitle>Acad Emerg Med</addtitle><description><![CDATA[Objectives
The main objective of this study was to evaluate the diagnostic accuracy of two novel biomarkers, calprotectin (CP) and serum amyloid A (SAA), along with the more traditional inflammatory markers C‐reactive protein (CRP) and white blood cell count (WBC), in patients suspected of having acute appendicitis (AA). The secondary objective was to compare diagnostic accuracy of these biomarkers with a clinical scoring system and radiologic imaging.
Methods
A total of 233 patients with suspected AA, presenting to the emergency department (ED) between January 2010 and September 2010, and 52 healthy individuals serving as controls, were included in the study. Blood was drawn and CP and SAA−1 concentrations were measured using enzyme‐linked immunosorbent assay (ELISA). CRP and WBC concentrations were routinely measured and retrospectively ed from the electronic health record, together with physical examination findings and radiologic reports. The Alvarado score was calculated as a clinical scoring system for AA. Final diagnosis of AA was based on histopathologic examination. The Mann‐Whitney U‐test was used for between‐group comparisons. Receiver operating characteristic (ROC) curves were used to measure the diagnostic accuracy for the tests and to determine the best cutoff points.
Results
Seventy‐seven of 233 patients (33%) had proven AA. Median plasma levels for CP and SAA−1 were significantly higher in patients with AA than in those with another final diagnosis (CP, 320.9 ng/mL vs. 212.9 ng/mL; SAA−1, 30 mg/mL vs. 0.6 mg/mL; p < 0.001). CRP and WBC were significantly higher in patients with AA as well. The Alvarado score was helpful at the extremes (<3 or >7). Ultrasound (US) had a sensitivity of 84% and a specificity of 94%. Computed tomography (CT) had a sensitivity of 100% and a specificity of 91%. The area under the ROC (95% confidence interval [CI]) was 0.67 (95% CI = 0.60 to 0.74) for CP, 0.76 (95% CI = 0.70 to 0.82) for SAA, 0.71 (95% CI = 0.64 to 0.78) for CRP, and 0.79 (95% CI = 0.73 to 0.85) for WBC. No cutoff points had high enough sensitivity and specificity to accurately diagnose AA. However, a high sensitivity of 97% was shown at 7.5 × 109/L for WBC and 0.375 mg/mL for SAA.
Conclusions
CP, SAA−1, CRP, and WBC were significantly elevated in patients with AA. None had cutoff points that could accurately discriminate between AA and other pathology in patients with suspected AA. A WBC < 7.5 × 109/L, with a low level of clinical suspicion for AA, can identify a subgroup of patients who may be sent home without further evaluation, but who should have available next‐day follow‐up.
Resumen
Evaluación de la Certeza Diagnóstica de Marcadores Plasmáticos para el Diagnóstico Precoz en los Pacientes con Sospecha de Apendicitis Aguda
Objetivos
El principal objetivo de este estudio fue evaluar la certeza diagnóstica en los pacientes con sospecha de tener una apendicitis aguda de dos nuevos biomarcadores, la calprotectina (CP) y el amiloide A sérico (AAS), junto con los marcadores inflamatorios más tradicionales, como la proteína C reactiva (PCR) y el número de leucocitos. El objetivo secundario fue comparar la certeza diagnóstica de estos biomarcadores con un sistema de puntuación clínica y la imagen radiológica.
Metodología
Se incluyeron en este estudio 233 pacientes con sospecha de apendicitis que acudieron al servicio de urgencias (SU) entre enero de 2010 y septiembre de 2010, y 52 individuos sanos que sirvieron como controles. Se extrajo sangre y se midió la CP y el AAS mediante un ELISA. La PCR y el número de leucocitos se midieron de forma rutinaria y se recogieron de forma retrospectiva de las historias clínicas electrónicas, junto con los hallazgos de la exploración física y los informes radiológicos. La escala Alvarado (Alvarado score) se calculó como un sistema de puntuación clínica para la apendicitis aguda. El diagnóstico final de apendicitis aguda se basó en el examen histopatológico. Se utilizó el test de la U de Mann‐Whitney para la comparación entre los grupos. Las curvas ROC se utilizaron para medir la certeza diagnóstica de las pruebas diagnósticas y para determinar los mejores puntos de corte.
Resultados
Setenta y siete de 233 pacientes (33%) tuvieron apendicitis aguda con certeza. Las medianas de los niveles plasmáticos de CP y AAS fueron significativamente más altas en los pacientes con apendicitis aguda que en aquellos con otro diagnóstico final (CP 321 ng/mL vs. 213 ng/mL; AAS 30 mg/mL vs. 0,6 mg/mL; p < 0,001). La PCR y los leucocitos estaban también significativamente más elevados en los pacientes con apendicitis aguda. La escala de Alvarado fue de ayuda en los extremos (< 3 o > 7). La ecografía tuvo una sensibilidad de un 84% y una especificidad de un 94%. La tomografía computarizada (TC) tuvo una sensibilidad de un 100% y una especificidad de un 91%. La curva ROC (intervalo de confianza 95%) fue de 0,67 (IC 95% = 0,60 a 0,74) para la CP, de 0,76 (IC 95% = 0,70 a 0,82) para la AAS, de 0,71 (IC 95%= 0,64 a 0,78) para la PCR y de 0,79 (IC 95%= 0,73 a 0,85) para los leucocitos.
Conclusiones
La CP, la AAS, la PCR y el número de leucocitos estaban significativamente elevados en los pacientes con apendicitis aguda. No hay un punto de corte que pueda discriminar de forma certera entre la apendicitis aguda y otra patología en los pacientes con sospecha de apendicitis aguda. Un número de leucocitos < 7,5 × 109/L, con un bajo nivel de sospecha clínica para la apendicitis aguda, puede identificar un subgrupo de pacientes que puede ser enviado a casa sin más evaluaciones, aunque estos pacientes deberían disponer de un seguimiento al día siguiente.]]></description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Appendectomy - methods</subject><subject>Appendicitis</subject><subject>Appendicitis - blood</subject><subject>Appendicitis - diagnosis</subject><subject>Appendicitis - surgery</subject><subject>Biomarkers</subject><subject>Biomarkers - blood</subject><subject>C-Reactive Protein - metabolism</subject><subject>Case-Control Studies</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Confidence Intervals</subject><subject>Early Diagnosis</subject><subject>Emergency medical care</subject><subject>Emergency Service, Hospital</subject><subject>Enzyme-Linked Immunosorbent Assay</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Leukocyte Count</subject><subject>Leukocyte L1 Antigen Complex - blood</subject><subject>Leukocytes</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Proteins</subject><subject>Radiology</subject><subject>ROC Curve</subject><subject>Sensitivity and Specificity</subject><subject>Serum Amyloid A Protein - metabolism</subject><subject>Severity of Illness Index</subject><subject>Statistics, Nonparametric</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>1069-6563</issn><issn>1553-2712</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><recordid>eNp90ctO3DAUBmCrKmJgyqYPUFnqpkIKnGPn5mU0DG0lECMV1pHHOQHT3LCT0nl7PAywYIE3tnQ-_7b0M_YV4QTDOtWG2hMUmMIndoBJIiORofgczpCqKE1SOWOH3t8DQJKpbJ_NhMwTleTxAfu__KebSY-273hf8_GO-JnVt13vR2t4YczktNlsR6tG-1bzS-3-kvO87h1fatdsXr313HZ8FaKoGz3_M_mBzEjVsyzMNBIvhoG6yho7Wv-F7dW68XT0ss_ZzfnyevErurj6-XtRXERGKgkR5nG8TmIZUw5KmEzlhmItMIEUU6MrAiMglUpgpcJQIiqVgZKpUapeA8o5-7HLHVz_MJEfy9Z6Q02jO-onX2IMCAog3J2z7-_ofT-5LvwuKBR5eBGyoI53yrjee0d1OTjbarcpEcptH-W2j_K5j4C_vURO65aqN_paQAC4A4-2oc0HUWWxWF7uQp8AjpGTcQ</recordid><startdate>201307</startdate><enddate>201307</enddate><creator>Schellekens, Dirk H. S. M.</creator><creator>Hulsewé, Karel W. E.</creator><creator>Acker, Bernadette A. C.</creator><creator>Bijnen, Annemarie A.</creator><creator>Jaegere, Tom M. H.</creator><creator>Sastrowijoto, Suprapto H.</creator><creator>Buurman, Wim A.</creator><creator>Derikx, Joep P. M.</creator><creator>Lewis, Lawrence</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>201307</creationdate><title>Evaluation of the Diagnostic Accuracy of Plasma Markers for Early Diagnosis in Patients Suspected for Acute Appendicitis</title><author>Schellekens, Dirk H. S. M. ; Hulsewé, Karel W. E. ; Acker, Bernadette A. C. ; Bijnen, Annemarie A. ; Jaegere, Tom M. H. ; Sastrowijoto, Suprapto H. ; Buurman, Wim A. ; Derikx, Joep P. M. ; Lewis, Lawrence</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3930-1844b5434e8092c798ce4a2150616cade0c2063921d97983119970936c99fb013</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Appendectomy - methods</topic><topic>Appendicitis</topic><topic>Appendicitis - blood</topic><topic>Appendicitis - diagnosis</topic><topic>Appendicitis - surgery</topic><topic>Biomarkers</topic><topic>Biomarkers - blood</topic><topic>C-Reactive Protein - metabolism</topic><topic>Case-Control Studies</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Confidence Intervals</topic><topic>Early Diagnosis</topic><topic>Emergency medical care</topic><topic>Emergency Service, Hospital</topic><topic>Enzyme-Linked Immunosorbent Assay</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Leukocyte Count</topic><topic>Leukocyte L1 Antigen Complex - blood</topic><topic>Leukocytes</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Proteins</topic><topic>Radiology</topic><topic>ROC Curve</topic><topic>Sensitivity and Specificity</topic><topic>Serum Amyloid A Protein - metabolism</topic><topic>Severity of Illness Index</topic><topic>Statistics, Nonparametric</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schellekens, Dirk H. S. M.</creatorcontrib><creatorcontrib>Hulsewé, Karel W. E.</creatorcontrib><creatorcontrib>Acker, Bernadette A. C.</creatorcontrib><creatorcontrib>Bijnen, Annemarie A.</creatorcontrib><creatorcontrib>Jaegere, Tom M. H.</creatorcontrib><creatorcontrib>Sastrowijoto, Suprapto H.</creatorcontrib><creatorcontrib>Buurman, Wim A.</creatorcontrib><creatorcontrib>Derikx, Joep P. M.</creatorcontrib><creatorcontrib>Lewis, Lawrence</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Academic emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schellekens, Dirk H. S. M.</au><au>Hulsewé, Karel W. E.</au><au>Acker, Bernadette A. C.</au><au>Bijnen, Annemarie A.</au><au>Jaegere, Tom M. H.</au><au>Sastrowijoto, Suprapto H.</au><au>Buurman, Wim A.</au><au>Derikx, Joep P. M.</au><au>Lewis, Lawrence</au><au>Lewis, Lawrence</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of the Diagnostic Accuracy of Plasma Markers for Early Diagnosis in Patients Suspected for Acute Appendicitis</atitle><jtitle>Academic emergency medicine</jtitle><addtitle>Acad Emerg Med</addtitle><date>2013-07</date><risdate>2013</risdate><volume>20</volume><issue>7</issue><spage>703</spage><epage>710</epage><pages>703-710</pages><issn>1069-6563</issn><eissn>1553-2712</eissn><abstract><![CDATA[Objectives
The main objective of this study was to evaluate the diagnostic accuracy of two novel biomarkers, calprotectin (CP) and serum amyloid A (SAA), along with the more traditional inflammatory markers C‐reactive protein (CRP) and white blood cell count (WBC), in patients suspected of having acute appendicitis (AA). The secondary objective was to compare diagnostic accuracy of these biomarkers with a clinical scoring system and radiologic imaging.
Methods
A total of 233 patients with suspected AA, presenting to the emergency department (ED) between January 2010 and September 2010, and 52 healthy individuals serving as controls, were included in the study. Blood was drawn and CP and SAA−1 concentrations were measured using enzyme‐linked immunosorbent assay (ELISA). CRP and WBC concentrations were routinely measured and retrospectively ed from the electronic health record, together with physical examination findings and radiologic reports. The Alvarado score was calculated as a clinical scoring system for AA. Final diagnosis of AA was based on histopathologic examination. The Mann‐Whitney U‐test was used for between‐group comparisons. Receiver operating characteristic (ROC) curves were used to measure the diagnostic accuracy for the tests and to determine the best cutoff points.
Results
Seventy‐seven of 233 patients (33%) had proven AA. Median plasma levels for CP and SAA−1 were significantly higher in patients with AA than in those with another final diagnosis (CP, 320.9 ng/mL vs. 212.9 ng/mL; SAA−1, 30 mg/mL vs. 0.6 mg/mL; p < 0.001). CRP and WBC were significantly higher in patients with AA as well. The Alvarado score was helpful at the extremes (<3 or >7). Ultrasound (US) had a sensitivity of 84% and a specificity of 94%. Computed tomography (CT) had a sensitivity of 100% and a specificity of 91%. The area under the ROC (95% confidence interval [CI]) was 0.67 (95% CI = 0.60 to 0.74) for CP, 0.76 (95% CI = 0.70 to 0.82) for SAA, 0.71 (95% CI = 0.64 to 0.78) for CRP, and 0.79 (95% CI = 0.73 to 0.85) for WBC. No cutoff points had high enough sensitivity and specificity to accurately diagnose AA. However, a high sensitivity of 97% was shown at 7.5 × 109/L for WBC and 0.375 mg/mL for SAA.
Conclusions
CP, SAA−1, CRP, and WBC were significantly elevated in patients with AA. None had cutoff points that could accurately discriminate between AA and other pathology in patients with suspected AA. A WBC < 7.5 × 109/L, with a low level of clinical suspicion for AA, can identify a subgroup of patients who may be sent home without further evaluation, but who should have available next‐day follow‐up.
Resumen
Evaluación de la Certeza Diagnóstica de Marcadores Plasmáticos para el Diagnóstico Precoz en los Pacientes con Sospecha de Apendicitis Aguda
Objetivos
El principal objetivo de este estudio fue evaluar la certeza diagnóstica en los pacientes con sospecha de tener una apendicitis aguda de dos nuevos biomarcadores, la calprotectina (CP) y el amiloide A sérico (AAS), junto con los marcadores inflamatorios más tradicionales, como la proteína C reactiva (PCR) y el número de leucocitos. El objetivo secundario fue comparar la certeza diagnóstica de estos biomarcadores con un sistema de puntuación clínica y la imagen radiológica.
Metodología
Se incluyeron en este estudio 233 pacientes con sospecha de apendicitis que acudieron al servicio de urgencias (SU) entre enero de 2010 y septiembre de 2010, y 52 individuos sanos que sirvieron como controles. Se extrajo sangre y se midió la CP y el AAS mediante un ELISA. La PCR y el número de leucocitos se midieron de forma rutinaria y se recogieron de forma retrospectiva de las historias clínicas electrónicas, junto con los hallazgos de la exploración física y los informes radiológicos. La escala Alvarado (Alvarado score) se calculó como un sistema de puntuación clínica para la apendicitis aguda. El diagnóstico final de apendicitis aguda se basó en el examen histopatológico. Se utilizó el test de la U de Mann‐Whitney para la comparación entre los grupos. Las curvas ROC se utilizaron para medir la certeza diagnóstica de las pruebas diagnósticas y para determinar los mejores puntos de corte.
Resultados
Setenta y siete de 233 pacientes (33%) tuvieron apendicitis aguda con certeza. Las medianas de los niveles plasmáticos de CP y AAS fueron significativamente más altas en los pacientes con apendicitis aguda que en aquellos con otro diagnóstico final (CP 321 ng/mL vs. 213 ng/mL; AAS 30 mg/mL vs. 0,6 mg/mL; p < 0,001). La PCR y los leucocitos estaban también significativamente más elevados en los pacientes con apendicitis aguda. La escala de Alvarado fue de ayuda en los extremos (< 3 o > 7). La ecografía tuvo una sensibilidad de un 84% y una especificidad de un 94%. La tomografía computarizada (TC) tuvo una sensibilidad de un 100% y una especificidad de un 91%. La curva ROC (intervalo de confianza 95%) fue de 0,67 (IC 95% = 0,60 a 0,74) para la CP, de 0,76 (IC 95% = 0,70 a 0,82) para la AAS, de 0,71 (IC 95%= 0,64 a 0,78) para la PCR y de 0,79 (IC 95%= 0,73 a 0,85) para los leucocitos.
Conclusiones
La CP, la AAS, la PCR y el número de leucocitos estaban significativamente elevados en los pacientes con apendicitis aguda. No hay un punto de corte que pueda discriminar de forma certera entre la apendicitis aguda y otra patología en los pacientes con sospecha de apendicitis aguda. Un número de leucocitos < 7,5 × 109/L, con un bajo nivel de sospecha clínica para la apendicitis aguda, puede identificar un subgrupo de pacientes que puede ser enviado a casa sin más evaluaciones, aunque estos pacientes deberían disponer de un seguimiento al día siguiente.]]></abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>23859584</pmid><doi>10.1111/acem.12160</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1069-6563 |
| ispartof | Academic emergency medicine, 2013-07, Vol.20 (7), p.703-710 |
| issn | 1069-6563 1553-2712 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1401090098 |
| source | Wiley |
| subjects | Adolescent Adult Aged Appendectomy - methods Appendicitis Appendicitis - blood Appendicitis - diagnosis Appendicitis - surgery Biomarkers Biomarkers - blood C-Reactive Protein - metabolism Case-Control Studies Child Child, Preschool Confidence Intervals Early Diagnosis Emergency medical care Emergency Service, Hospital Enzyme-Linked Immunosorbent Assay Female Follow-Up Studies Humans Leukocyte Count Leukocyte L1 Antigen Complex - blood Leukocytes Male Middle Aged Proteins Radiology ROC Curve Sensitivity and Specificity Serum Amyloid A Protein - metabolism Severity of Illness Index Statistics, Nonparametric Treatment Outcome Young Adult |
| title | Evaluation of the Diagnostic Accuracy of Plasma Markers for Early Diagnosis in Patients Suspected for Acute Appendicitis |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-29T20%3A29%3A19IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Evaluation%20of%20the%20Diagnostic%20Accuracy%20of%20Plasma%20Markers%20for%20Early%20Diagnosis%20in%20Patients%20Suspected%20for%20Acute%20Appendicitis&rft.jtitle=Academic%20emergency%20medicine&rft.au=Schellekens,%20Dirk%20H.%20S.%20M.&rft.date=2013-07&rft.volume=20&rft.issue=7&rft.spage=703&rft.epage=710&rft.pages=703-710&rft.issn=1069-6563&rft.eissn=1553-2712&rft_id=info:doi/10.1111/acem.12160&rft_dat=%3Cproquest_cross%3E1401090098%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c3930-1844b5434e8092c798ce4a2150616cade0c2063921d97983119970936c99fb013%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1412861607&rft_id=info:pmid/23859584&rfr_iscdi=true |