Biomarkers for Detecting Surgical Emergency in Acute Abdomen-A Prospective Observational Study.

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.