Predictive Value of Procalcitonin for Intestinal Ischemia And/or Necrosis in Pediatric Patients with Adhesive Small Bowel Obstruction (ASBO)

Purpose: Evaluate serum procalcitonin (PCT) level as a predictor of intestinal ischemia or necrosis (IN) in patients with postoperative adhesive small bowel obstruction (ASBO).

Methods: Prospective cohort of consecutive patients with ASBO. Patients previously treated with antibiotics or septic were excluded. PCT was measured at the diagnosis of ASBO and every 24 h afterwards.

Main Outcome: Intestinal necrosis (IN) in 10 patients (21.3%). Mean PCT level was higher in patients with IN (15.11 ng/ml vs. 0.183 ng/ml, p=0.002), the proportion of patients with elevated PCT (>0.5 ng/dl) was higher in patients with IN (70% vs. 8.1%, p=<0.001, RR=26.4 with a 95% CI of 4.39-159.5). Elevated PCT levels at diagnosis had a 70% positive predictive value (PPV) and 91.8% negative predictive value (NPV) for prediction of IN. With a PCT value at diagnosis of >1.0 ng/dl, PPV was 87.5% and NPV, 92.3%.

Results: Fifty-nine patients were included, 12 of whom were excluded; 47 patients remained in the study; male-to-female ratio = 1.9:1.

Management: medical in 15 cases (32%) and surgical in 32 (68%).

Conclusions: PCT levels are closely related to the presence of intestinal ischemia and necrosis in children with ASBO.

Level Of Evidence: Study of Diagnostic Test, Level II.