Inflammatory Biomarkers and Clinical Judgment in the Emergency Diagnosis of Urgent Abdominal Pain

被引:7
作者
Breidthardt, Tobias [1 ,2 ,3 ]
Brunner-Schaub, Nora [1 ]
Balmelli, Catharina [1 ]
Sancho Insenser, Juan Jose [4 ]
Burri-Winkler, Katrin [1 ,4 ]
Geigy, Nicolas [5 ]
Mundorff, Lukas [5 ]
Exadaktylos, Aristomenis [6 ]
Scholz, Julia [1 ]
Haaf, Philip [1 ,3 ,7 ]
Hamel, Christian [3 ,8 ,9 ]
Frey, Daniel [3 ,8 ,10 ]
Delport, Karen [11 ]
Peacock, W. Frank [12 ]
Freese, Michael [1 ,3 ,7 ]
DiSomma, Salvatore [13 ]
Todd, John [14 ]
Rentsch, Katharina [3 ,15 ]
Bingisser, Roland [3 ,16 ]
Mueller, Christian [1 ,3 ,7 ]
Walter, Joan [1 ,3 ,7 ]
Twerenbold, Raphael [1 ,3 ,17 ,18 ]
Nestelberger, Thomas [1 ,3 ,17 ]
Boeddinghaus, Jasper [1 ,3 ,17 ]
Badertscher, Patrick [1 ,3 ,17 ]
de Lavallaz, Jeanne du Fay [1 ,3 ,17 ]
Puelacher, Christian [1 ,3 ,17 ]
Wildi, Karin [1 ,3 ,17 ]
机构
[1] CRIB, Basel, Switzerland
[2] Univ Hosp, Dept Internal Med, Basel, Switzerland
[3] Univ Basel, Basel, Switzerland
[4] Hosp del Mar, Barcelona, Spain
[5] Kantonsspital Baselland, Liestal, Switzerland
[6] Inselspital Bern, Emergency Dept, Bern, Switzerland
[7] Univ Hosp, Dept Cardiol, Basel, Switzerland
[8] Univ Hosp, Dept Visceral Surg, Basel, Switzerland
[9] Kliniken Landkreises, Dept Visceral Surg, Lorrach, Germany
[10] Spital Wetzikon, Dept Surg, Wetzikon, Switzerland
[11] Kantonspital Baselland, Emergency Dept, Bruderholz, Switzerland
[12] Baylor Coll Med, Dept Emergency Med, Houston, TX 77030 USA
[13] Univ Sapienza, SanAndrea Hosp, Emergency Dept, Rome, Italy
[14] Singulex Inc, Clin Res, Alameda, CA USA
[15] Univ Hosp, Dept Lab Med, Basel, Switzerland
[16] Univ Hosp, Emergency Dept, Basel, Switzerland
[17] Univ Hosp, Dept Med, Basel, Switzerland
[18] Univ Heart Ctr Hamburg, Dept Gen & Intervent Cardiol, Hamburg, Germany
基金
瑞士国家科学基金会;
关键词
NATRIURETIC PEPTIDE; COMPUTED-TOMOGRAPHY; MYOCARDIAL-INFARCTION; EUROPEAN-SOCIETY; CARDIAC TROPONIN; HEART-FAILURE; TASK-FORCE; GUIDELINES; MANAGEMENT; IMPACT;
D O I
10.1373/clinchem.2018.296491
中图分类号
R446 [实验室诊断]; R-33 [实验医学、医学实验];
学科分类号
1001 ;
摘要
BACKGROUND: The early diagnosis of urgent abdominal pain (UAP) is challenging. Most causes of UAP are associated with extensive inflammation. Therefore, we hypothesized that quantifying inflammation using interleukin-6 and/or procalcitonin would provide incremental value in the emergency diagnosis of UAP. METHODS: This was an investigator-initiated prospective, multicenter diagnostic study enrolling patients presenting to the emergency department (ED) with acute abdominal pain. Clinical judgment of the treating physician regarding the presence of UAP was quantified using a visual analog scale after initial clinical and physician-directed laboratory assessment, and again after imaging. Two independent specialists adjudicated the final diagnosis and the classification as UAP (life-threatening, needing urgent surgery and/or hospitalization for acute medical reasons) using all information including histology and follow-up. Interleukin-6 and procalcitonin were measured blinded in a central laboratory. RESULTS: UAP was adjudicated in 376 of 1038 (36%) patients. Diagnostic accuracy for UAP was higher for interleukin-6 [area under the ROC curve (AUC), 0.80; 95% CI, 0.77-0.82] vs procalcitonin (AUC, 0.65; 95% CI, 0.62-0.68) and clinical judgment (AUC, 0.69; 95% CI, 0.65-0.72; both P < 0.001). Combined assessment of interleukin-6 and clinical judgment increased the AUC at presentation to 0.83 (95% CI, 0.80-0.85) and after imaging to 0.87 (95% CI, 0.84-0.89) and improved the correct identification of patients with and without UAP (net improvement in mean predicted probability: presentation, +19%; after imaging, +15%; P < 0.001). Decision curve analysis documented incremental value across the full range of pretest probabilities. A clinical judgment/interleukin-6 algorithm ruled out UAP with a sensitivity of 97% and ruled in UAP with a specificity of 93%. CONCLUSIONS: Interleukin-6 significantly improves the early diagnosis of UAP in the ED. (C) 2018 American Association for Clinical Chemistry
引用
收藏
页码:302 / 312
页数:11
相关论文
共 35 条
  • [1] What clinical and laboratory parameters determine significant intra abdominal pathology for patients assessed in hospital with acute abdominal pain?
    Abbas S.M.
    Smithers T.
    Truter E.
    [J]. World Journal of Emergency Surgery, 2 (1)
  • [2] Economic evaluation of the one-hour rule-out and rule-in algorithm for acute myocardial infarction using the high-sensitivity cardiac troponin T assay in the emergency department
    Ambavane, Apoorva
    Lindahl, Bertil
    Giannitis, Evangelos
    Rolz, Julie
    Mendivil, Joan
    Frankenstein, Lutz
    Body, Richard
    Christ, Michael
    Bingisser, Roland
    Alquezar, Aitor
    Mueller, Christian
    [J]. PLOS ONE, 2017, 12 (11):
  • [3] Australian Institute of Health and Welfare, 2017, AUSTR I HLTH WELF HL, V80
  • [4] Bhuiya FA, 2010, NCHS DATA BRIEF, P1
  • [5] Can emergency physicians 'rule in' and 'rule out' acute myocardial infarction with clinical judgement?
    Body, Richard
    Cook, Gary
    Burrows, Gillian
    Carley, Simon
    Lewis, Philip S.
    [J]. EMERGENCY MEDICINE JOURNAL, 2014, 31 (11) : 872 - 876
  • [6] Medical and economic long-term effects of B-type natriuretic peptide testing in patients with acute dyspnea
    Breidthardt, Tobias
    Laule, Kirsten
    Strohmeyer, Anne-Henny
    Schindler, Christian
    Meier, Sophie
    Fischer, Michael
    Scholer, Andre
    Noveanu, Markus
    Christ, Michael
    Perruchoud, Andre P.
    Mueller, Christian
    [J]. CLINICAL CHEMISTRY, 2007, 53 (08) : 1415 - 1422
  • [7] ABDOMINAL-PAIN - ANALYSIS OF 1,000 CONSECUTIVE CASES IN A UNIVERSITY HOSPITAL EMERGENCY ROOM
    BREWER, RJ
    GOLDEN, GT
    HITCH, DC
    RUDOLF, LE
    WANGENSTEEN, SL
    [J]. AMERICAN JOURNAL OF SURGERY, 1976, 131 (02) : 219 - 223
  • [8] Epidemiology and outcomes of acute abdominal pain in a large urban Emergency Department: retrospective analysis of 5,340 cases
    Cervellin, Gianfranco
    Mora, Riccardo
    Ticinesi, Andrea
    Meschi, Tiziana
    Comelli, Ivan
    Catena, Fausto
    Lippi, Giuseppe
    [J]. ANNALS OF TRANSLATIONAL MEDICINE, 2016, 4 (19)
  • [9] Procalcitonin as the Biomarker of Inflammation in Diagnosis of Appendicitis in Pediatric Patients and Prevention of Unnecessary Appendectomies
    Chandel, Vishal
    Batt, Sajjid Hussain
    Bhat, Mohammad Younis
    Kawoosa, Nadeem Ulnazeer
    Yousuf, Adfar
    Zargar, Babar Rashid
    [J]. INDIAN JOURNAL OF SURGERY, 2011, 73 (02) : 136 - 141
  • [10] COMPARING THE AREAS UNDER 2 OR MORE CORRELATED RECEIVER OPERATING CHARACTERISTIC CURVES - A NONPARAMETRIC APPROACH
    DELONG, ER
    DELONG, DM
    CLARKEPEARSON, DI
    [J]. BIOMETRICS, 1988, 44 (03) : 837 - 845