medigraphic.com
ISSN 2594-1518 (Electronic)
ISSN 1405-0099 (Print)

2025, Number 2

<< Back Next >>

Cir Gen 2025; 47 (2)

Serum procalcitonin as a diagnostic tool in severe acute cholangitis in a reference center in Mexico

Trinidad RW, Segura GJMC, López BCA

Language: Spanish
References: 23
Page: 76-81
PDF size: 352.37 Kb.


ABSTRACT

Introduction: acute cholangitis is a biliary tract infection. The Tokyo 2018 guidelines, used for diagnosis, suggest procalcitonin as a severity marker without defining a cut-off point. Objective: to analyze the association of procalcitonin with severe acute cholangitis. Material and methods: descriptive study. There were two groups: severe acute cholangitis (grade III) and non-severe (grade I and II); the levels of procalcitonin, C-reactive protein, leukocytes and total bilirubin were analyzed. Student's t test was used for unrelated independent samples; ROC curves, and the cut-off point was obtained according to the highest accuracy of the Youden index. The association measures were calculated with two-by-two contingency tables in SPSS version 29 for Windows. Results: statistical significance (p ≤ 0.001) of procalcitonin in severe cholangitis was found; and in the ROC analysis a cut-off point of 1.3 ng/ml was obtained with an accuracy of 83% (Youden index=0.83) with high associations (sensitivity = 93%, specificity = 90%, positive predictive value = 90%, negative predictive value = 93%). No statistical significance was found in C-reactive protein (p = 0.133), or total bilirubin (p = 0.304); the leukocytes (p = 0.038) had a statistical difference, but without clinical significance. Conclusions: procalcitonin obtained the best significant statistical difference, and the best association with severe acute cholangitis compared to other biochemical variables.


REFERENCES

  1. Charcot JM. Lecons sur les maladies du foie, des voies biliaires et des reins. 1ed. Paris: Bureaux du "Progrès Médical"; 1877, pp. 1-98.

  2. Kiriyama S, Kozaka K, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2018; 25: 17-30. doi: 10.1002/jhbp.512.

  3. Chan NC, Bandín MAR, Villalobos BI, Torres MA. Guía de práctica clínica, colangitis. Ciudad de México: Asociación Mexicana de Cirugía General; 2014. Disponible en: https://amcg.org.mx/wp-content/uploads/2023/09/colangitis.pdf

  4. Gomi H, Takada T, Hwang TL, Akazawa K, Mori R, Endo I et al. Updated comprehensive epidemiology, microbiology, and outcomes among patients with acute cholangitis. J Hepatobiliary Pancreat Sci. 2017; 24: 310-318. doi: 10.1002/jhbp.452.

  5. Shabanzadeh DM, Sorensen LT, Jorgensen T. A Prediction rule for risk stratification of incidentally discovered gallstones: results from a large cohort study. Gastroenterology. 2016; 150: 156-167.e1. doi: 10.1053/j.gastro.2015.09.002.

  6. Barbier L, Souche R, Slim K, Ah-Soune P. Long-term consequences of bile duct injury after cholecystectomy. J Visc Surg. 2014; 151: 269-279. doi: 10.1016/j.jviscsurg.2014.05.006.

  7. Payen JL, Muscari F, Vibert E, Ernst O, Pelletier G. Lithiase biliaire [Biliary lithiasis]. Presse Med. 2011; 40: 567-580. doi: 10.1016/j.lpm.2011.01.024.

  8. Sung JY, Costerton JW, Shaffer EA. Defense system in the biliary tract against bacterial infection. Dig Dis Sci. 1992; 37: 689-696. doi: 10.1007/BF01296423.

  9. Sulzer JK, Ocuin LM. Cholangitis: causes, diagnosis, and management. Surg Clin North Am. 2019; 99: 175-184. doi: 10.1016/j.suc.2018.11.002.

  10. Miura F, Okamoto K, Takada T, Strasberg SM, Asbun HJ, Pitt HA et al. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepatobiliary Pancreat Sci. 2018; 25: 31-40. doi: 10.1002/jhbp.509.

  11. Gomi H, Solomkin JS, Schlossberg D, Okamoto K, Takada T, Strasberg SM et al. Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2018; 25: 3-16. doi: 10.1002/jhbp.518.

  12. Mukai S, Itoi T, Baron TH, Takada T, Strasberg SM, Pitt HA et al. Indications and techniques of biliary drainage for acute cholangitis in updated Tokyo Guidelines 2018. J Hepatobiliary Pancreat Sci. 2017; 24: 537-549. doi: 10.1002/jhbp.496.

  13. Lu ZQ, Zhang HY, Su CF, Xing YY, Wang GX, Li CS. Optimal timing of biliary drainage based on the severity of acute cholangitis: A single-center retrospective cohort study. World J Gastroenterol. 2022; 28: 3934-3945. doi: 10.3748/wjg.v28.i29.3934.

  14. Umefune G, Kogure H, Hamada T, Isayama H, Ishigaki K, Takagi K et al. Procalcitonin is a useful biomarker to predict severe acute cholangitis: a single-center prospective study. J Gastroenterol. 2017; 52: 734-745. doi: 10.1007/s00535-016-1278-x.

  15. Suwa Y, Matsuyama R, Goto K, Kadokura T, Sato M, Mori R et al. IL-7 and procalcitonin are useful biomarkers in the comprehensive evaluation of the severity of acute cholangitis. J Hepatobiliary Pancreat Sci. 2017; 24: 81-88. doi: 10.1002/jhbp.420.

  16. Lee YS, Cho KB, Park KS, Lee JY, Lee YJ. Procalcitonin as a decision-supporting marker of urgent biliary decompression in acute cholangitis. Dig Dis Sci. 2018; 63: 2474-2479. doi: 10.1007/s10620-018-4963-1.

  17. Silangcruz K, Nishimura Y, Czech T, Kimura N, Yess J. Procalcitonin to predict severity of acute cholangitis and need for urgent biliary decompression: systematic scoping review. J Clin Med. 2022; 11: 1155. doi: 10.3390/jcm11051155.

  18. Korekawa K, Oki M, Kumimitsu A. Evaluation of the usefulness of procalcitonin as a biomarker for the diagnosis of acute cholangitis. J Abdom Emerg Med. 2020; 40: 809-816. https://jglobal.jst.go.jp/en/detail?JGLOBAL_ID=202002232096497360

  19. Lyu Y, Jiang H, Wang B, Yueming X, Weibing D, Cheng Y. The role of procalcitonin in patients with different severity grades of acute cholangitis. Chin J Hepatobiliary Surg. 2014; 20: 428-430. ID: wpr-453553

  20. Hamano K, Noguchi O, Matsumoto Y, Watabe T, Numata M, Yosioka A, et al. Usefulness of procalcitonin for severity assessment in patients with acute cholangitis. Clin Lab. 2013; 59: 177-83. doi: 10.7754/clin.lab.2012.120520.

  21. Shinya S, Sasaki T, Yamashita Y, Kato D, Yamashita K, Nakashima R et al. Procalcitonin as a useful biomarker for determining the need to perform emergency biliary drainage in cases of acute cholangitis. J Hepatobiliary Pancreat Sci. 2014; 21: 777-785. doi: 10.1002/jhbp.132.

  22. Souto-Rosillo MG, Bastida-González E, Vidal-Sánchez IE. Procalcitonina en la práctica clínica. Med Int Méx. 2019; 35: 927-930. doi: 10.24245/mim. v35i6.2779

  23. Santistevan KM, Zafra-Morales P, Gómez-Hidalgo J, et al. Biomarcadores diagnósticos de sepsis y shock séptico. Rev Cient Abrit Multidiscip Pentaciencias. 2023; 5: 413-423. doi: 10.59169/pentaciencias.v5i3.558.




2020     |     www.medigraphic.com