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Serum procalcitonin for the diagnosis of severe acute colangitis
Serum procalcitonin for the diagnosis of severe acute colangitis
Williams Trinidad-Rodríguez 1 
, José M.C. Segura-González 2 , Carlos A. López-Bernal 3 , Arturo García-Galicia 4 , Nancy R. Bertado-Ramírez 5 , Álvaro J. Montiel-Jarquín 4 , Susana Barrera-Hernández 6 , Angélica Porras-Juárez 7 , José A. Parra-Salazar 8
1 Departamento de Cirugía General, Hospital de Especialidades de Puebla, Instituto Mexicano del Seguro Social, Puebla, Pue., México; 2 Departamento de Cirugía General, Hospital de Especialidades de Puebla, Instituto Mexicano del Seguro Social, Puebla, Puebla, México; 3 Departamento de Cirugía General, Hospital de Especialidades de Puebla, Instituto Mexicano del Seguro Social (IMSS), Puebla, Puebla, México; 4 Dirección de Educación e Investigación en Salud. Unidad Médica de Alta Especialidad, Hospital de Especialidades de Puebla, Centro Médico Nacional Gral. de Div. Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla de Zaragoza, Pue., México; 5 Directorate of Health Education and Research, Centro Médico Nacional Gral. de Div. Manuel Ávila Camacho. Puebla, Pue., Mexico; 6 División de Investigación, Unidad Médica de Alta Especialidad Hospital de Especialidades de Puebla, Centro Médico Nacional General de División Manuel Ávila Camacho, IMSS, Puebla de Zaragoza, México; 7 Dirección de Educación e Investigación enSalud, Hospital de Especialidades de Puebla, Instituto Mexicano del Seguro Social, Puebla, Puebla, México; 8 Dirección General, Hospital de Especialidades Puebla, Centro Médico Nacional General de División Manuel Ávila Camacho, Puebla, Pue., México
*Correspondence: Álvaro J. Montiel-Jarquín. Email: dralmoja@hotmail.com
Abstract
Background: Acute cholangitis is an infection of the bile duct. 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 and non-severe. Levels of procalcitonin, C-reactive protein, leukocytes and total bilirubin were analyzed. Student’ s t-test was used for unrelated independent samples; ROC curves. The cut-off point was obtained according to the highest accuracy of the Youden index.
Results: Procalcitonin has a cut-off value of 1.35 ng/ml in severe acute cholangitis (p = 0.001), with a sensitivity of 93%, a specificity of 90%, a positive predictive value of 90%, a negative predictive value of 93% and a Youden index of 0.83%. C-reactive protein and total bilirubin values had no statistical significance for diagnosing severe acute cholangitis (p = 0.133 and p = 0.304, respectively). Leukocytes were statistically significant (p = 0.038) but were not clinically significant for severe acute cholangitis.
Conclusions: A procalcitonin value of 1.35 ng/ml is the cut-off point for diagnosing severe acute cholangitis.
Keywords: Cholangitis. Procalcitonin. Sepsis. Hyperbilirubinemia. Jaundice.
