Inflammatory Biomarkers and Clinical Judgment in the Emergency Diagnosis of Urgent Abdominal Pain
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Inflammatory Biomarkers and Clinical Judgment in the Emergency Diagnosis of Urgent Abdominal Pain. / BASEL VII Investigators.
in: CLIN CHEM, Jahrgang 65, Nr. 2, 02.2019, S. 302-312.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Inflammatory Biomarkers and Clinical Judgment in the Emergency Diagnosis of Urgent Abdominal Pain
AU - Breidthardt, Tobias
AU - Brunner-Schaub, Nora
AU - Balmelli, Catharina
AU - Insenser, Juan Jose Sancho
AU - Burri-Winkler, Katrin
AU - Geigy, Nicolas
AU - Mundorff, Lukas
AU - Exadaktylos, Aristomenis
AU - Scholz, Julia
AU - Haaf, Philip
AU - Hamel, Christian
AU - Frey, Daniel
AU - Delport, Karen
AU - Peacock, W Frank
AU - Freese, Michael
AU - DiSomma, Salvatore
AU - Todd, John
AU - Rentsch, Katharina
AU - Bingisser, Roland
AU - Mueller, Christian
AU - Walter, Joan
AU - Twerenbold, Raphael
AU - Nestelberger, Thomas
AU - Boeddinghaus, Jasper
AU - Badertscher, Patrick
AU - du Fay de Lavallaz, Jeanne
AU - Puelacher, Christian
AU - Wildi, Karin
AU - BASEL VII Investigators
N1 - © 2018 American Association for Clinical Chemistry.
PY - 2019/2
Y1 - 2019/2
N2 - 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.
AB - 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.
KW - Abdomen/diagnostic imaging
KW - Abdominal Pain/diagnosis
KW - Adult
KW - Aged
KW - Algorithms
KW - Area Under Curve
KW - Biomarkers/blood
KW - Emergency Service, Hospital
KW - Female
KW - Humans
KW - Interleukin-6/blood
KW - Judgment
KW - Male
KW - Middle Aged
KW - Procalcitonin/blood
KW - Prospective Studies
KW - ROC Curve
KW - Tomography, X-Ray Computed
U2 - 10.1373/clinchem.2018.296491
DO - 10.1373/clinchem.2018.296491
M3 - SCORING: Journal article
C2 - 30518662
VL - 65
SP - 302
EP - 312
JO - CLIN CHEM
JF - CLIN CHEM
SN - 0009-9147
IS - 2
ER -
