Diagnostic Value of Serum Procalcitonin in Appendicitis in Infants and Young Children: Retrospective Cohort Study

Background: An increasing number of studies have indicated that uncomplicated acute appendicitis can be cured with antibiotics alone. Reducing the hazards of appendicitis in infants and young children is a priority problem. It is necessary to search for potential biomarkers for early diagnosis of appendicitis in infants and young children. Methods: A retrospective cohort study, including 366 infants and young children treated in the pediatric surgery department, was conducted. Complete blood count, C-reactive protein, and procalcitonin were measured at admission and 24 hours after operation. Results: The median of PCT, CRP, and WBC in the acute appendicitis group and other diseases group were 1.20, 0.11 - 4.06; 16.50, 0.81 - 76.21; 13.51, 7.53 - 26.30 and 0.03, 0.01 - 0.13; 3.35, 0.92 - 6.33; 14.34, 8.84 - 17.23 at the admission, respectively. PCT and CRP were found higher in the acute appendicitis group than that in other abdominal pain diseases group (p < 0.05). WBC is not a specific indicator for identifying acute appendicitis and other abdominal pain diseases (p > 0.05). In different acute appendicitis cases, PCT and CRP significantly increased in complicated appendicitis (p < 0.05). Data showed that WBC mildly increased in complicated appendicitis compared to acute simple appendicitis (p < 0.05). ROC curves showed that PCT was a specific indicator for identifying acute appendicitis and other abdominal pain diseases, AUCPCT = 1.000 (95% CI, 0.999 - 1.000). The median of antibiotic treatment is 4.0 d (95% CI 3.0 - 5.0) in acute appendicitis with PCT results versus 7.0 d (95% CI 5.0 - 9.0) in acute appendicitis without PCT result. Conclusions: PCT shows a high diagnostic ability for appendicitis in infants and young children at admission and assists pediatricians in management of pediatric appendicitis. The combination of these biomarkers is highly recommended. Further studies are needed to confirm our findings.