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 4 , Álvaro J. Montiel-Jarquín 5 , 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 Department of Coloproctology. High Specialty Medical Unit Hospital de Especialidades, Centro Médico Nacional Gral. de Div. Manuel Ávila Camacho, IMSS. Puebla de Zaragoza, Puebla, Mexico; 4 Dirección de Educación e Investigación en Salud. Hospital de Especialidades de Puebla, Instituto Mexicano del Seguro Social, Puebla, Pue., México; 5 Dirección de Educación e Investigación en Salud, Centro Médico Nacional Gral. de Div. Manuel Ávila Camacho, Hospital de Especialidades de Puebla, Instituto Mexicano del Seguro Social (IMSS) Puebla, México; 6 Departamento de Medicina Interna, Hospital de Especialidades de Puebla, Instituto Mexicano del Seguro Social, 2Departamento de Medicina Interna, Hospital de Especialidades de Puebla, Instituto Mexicano del Seguro Social; 7 Dirección de Educación e Investigación en Salud, Hospital de Especialidades de Puebla, Instituto Mexicano del Seguro Social, Puebla, Puebla, México; 8 Dirección General, Hospital de Especialidades de Puebla, Instituto Mexicano del Seguro Social, Puebla, Puebla, México
*Correspondence: Álvaro J. Montiel-Jarquín. Email: alvaro.montielj@imss.gob.mx
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.
