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

Breidthardt, Tobias and Brunner-Schaub, Nora and Balmelli, Catharina and Insenser, Juan Jose Sancho and Burri-Winkler, Katrin and Geigy, Nicolas and Mundorff, Lukas and Exadaktylos, Aristomenis and Scholz, Julia and Haaf, Philip and Hamel, Christian and Frey, Daniel and Delport, Karen and Peacock, W. Frank and Freese, Michael and DiSomma, Salvatore and Todd, John and Rentsch, Katharina and Bingisser, Roland and Mueller, Christian and Walter, Joan and Twerenbold, Raphael and Nestelberger, Thomas and Boeddinghaus, Jasper and Badertscher, Patrick and du Fay de Lavallaz, Jeanne and Puelacher, Christian and Wildi, Karin. (2019) Inflammatory Biomarkers and Clinical Judgment in the Emergency Diagnosis of Urgent Abdominal Pain. Clinical Chemistry, 65 (2). pp. 302-312.

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Official URL: https://edoc.unibas.ch/71169/

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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.; 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.; 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%.; Interleukin-6 significantly improves the early diagnosis of UAP in the ED.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
UniBasel Contributors:Müller, Christian and Breidthardt, Tobias
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:American Association for Clinical Chemistry
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:08 Dec 2020 07:59
Deposited On:09 Apr 2020 14:26

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