Inflammatory biomarkers and clinical judgment in the emergency diagnosis of urgent abdominal pain
| العنوان: | Inflammatory biomarkers and clinical judgment in the emergency diagnosis of urgent abdominal pain |
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| المؤلفون: | Patrick Badertscher, Christian Puelacher, Raphael Twerenbold, Jasper Boeddinghaus, Aristomenis K. Exadaktylos, Lukas Mundorff, Salvatore DiSomma, Karin Wildi, Jeanne du Fay de Lavallaz, Katharina Rentsch, John Todd, Juan Jose Sancho Insenser, Katrin Burri-Winkler, W. Frank Peacock, Catharina Balmelli, Joan Walter, Christian Mueller, Tobias Breidthardt, Christian T. Hamel, Michael Freese, Julia Scholz, Karen Delport, Roland Bingisser, Thomas Nestelberger, Nicolas Geigy, Philip Haaf, Daniel M. Frey, Nora Brunner-Schaub |
| المساهمون: | University of Basel (Unibas), University Hospital Basel [Basel], IMIM-Hospital del Mar, Generalitat de Catalunya, Inselspital Bern, Institut des Neurosciences de Montpellier - Déficits sensoriels et moteurs (INM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Baylor College of Medicine (BCM), Baylor University, Università degli Studi di Roma 'La Sapienza' = Sapienza University [Rome] |
| المصدر: | Clinical Chemistry Clinical Chemistry, American Association for Clinical Chemistry, 2019, 65 (2), pp.302-312. ⟨10.1373/clinchem.2018.296491⟩ |
| بيانات النشر: | American Association for Clinical Chemistry Inc., 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | Adult, Male, medicine.medical_specialty, Abdominal pain, biomarkers, abdominal pain, tomografia computerizzata, Visual analogue scale, Clinical Biochemistry, 030204 cardiovascular system & hematology, Procalcitonin, Judgment, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Abdomen, Humans, Medicine, Prospective Studies, Prospective cohort study, Aged, Interleukin-6, business.industry, Biochemistry (medical), 030208 emergency & critical care medicine, Emergency department, Middle Aged, Clinical judgment, Inflammatory biomarkers, 3. Good health, ROC Curve, Area Under Curve, Female, medicine.symptom, Emergency Service, Hospital, Tomography, X-Ray Computed, business, Area under the roc curve, Algorithms, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology |
| الوصف: | 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. |
| وصف الملف: | application/pdf |
| اللغة: | English |
| تدمد: | 0009-9147 1530-8561 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::24ab592f4c1f83dcaec8212bff8e29f6Test http://hdl.handle.net/11573/1307765Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....24ab592f4c1f83dcaec8212bff8e29f6 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 00099147 15308561 |
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