Pro-adrenomedullin: Akut apandisit için yeni bir taný biyobelirteci

AMAÇ: Karýn aðrýsý þikâyetiyle acil servise (AS) baþvuran hastalarda, serum pro-adrenomedullin (Pro-ADM) düzeylerinin akut apandisit (AA) tanýsýndaki deðerini deðerlendirmek.
GEREÇ VE YÖNTEM: Bu prospektif klinik çalýþmaya, 18 yaþ üstü ve acil servise karýn aðrýsý nedeniyle baþvuran, baþlangýçta apandisit þüphesi bulunan hastalar dâhil edildi. Her hastadan baþvuru sýrasýnda venöz kan örneði alýndý ve serum Pro-ADM düzeyleri ölçüldü. Laboratuvar ve radyolojik deðerlendirmelere göre hastalar iki gruba ayrýldý: AA tanýsý konulanlar ve konulmayanlar. AA tanýsý konulanlar ayrýca basit ve komplike AA olarak alt gruplara ayrýldý. Tüm istatistiksel analizler, SPSS for Windows sürüm 21.0 (SPSS Inc., Chicago, IL, ABD) programý kullanýlarak yapýldý. p<0.05 deðeri istatistiksel olarak anlamlý kabul edildi.
BULGULAR: Çalýþmaya karýn aðrýsý olan toplam 83 eriþkin hasta dâhil edildi; bunlarýn 44’ü erkek (%53.0), 39’u kadýndý (%47.0). Hastalarýn yaþ ortalamasý 32.28±16.10 yýl idi. Apandisit tanýsý alan hastalarda serum Pro-ADM düzeyleri, taný almayanlara göre daha yüksekti. Pro-ADM için eþik deðerin 3.375 pg/mL olarak belirlenmesi, apandisit tanýsý konulan ve konulmayan hastalar arasýnda istatistiksel olarak anlamlý bir fark ortaya koydu (p=0.002). Ayrýca, apandisit tanýsý alan hastalarýn acil servise baþvuru süreleriyle serum Pro-ADM düzeyleri arasýnda da anlamlý bir iliþki saptandý (p<0.001).
SONUÇ: Serum Pro-ADM düzeyleri, apandisitli hastalarda yükselmektedir ancak basit ve komplike apandisit ayrýmýnda yeterince etkili deðildir. Bununla birlikte, karýn aðrýsý baþlangýcýnýn ilk 24 saati içinde acil servise baþvuran hastalarda Pro-ADM düzeyleri, erken tanýda faydalý olabilir.

Anahtar Kelimeler: Akut karýn aðrýsý, akut apandisit, acil servis, biyobelirteç, pro-adrenomedullin

Pro-adrenomedullin: a novel diagnostic biomarker of acute appendicitis

BACKGROUND: The objective of this study was to evaluate the diagnostic value of serum pro-adrenomedullin (pro-ADM) levels in diagnosing acute appendicitis (AA) in patients presenting to the emergency department (ED) with abdominal pain.
METHODS: This prospective clinical study included patients over the age of 18 who presented to the ED with abdominal pain and were initially suspected of having appendicitis. A venous blood sample was collected from each patient upon presentation, and serum pro-ADM levels were measured. Based on laboratory and radiological evaluations, patients were categorized into two groups: those diagnosed with AA and those without AA. The AA group was further subdivided into simple and complicated AA. All statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) for Windows, version 21.0 (SPSS Inc., Chicago, IL, USA). A p-value of <0.05 was considered statistically significant.
RESULTS: This study included 83 adult patients with abdominal pain, of whom 44 were male (53.0%) and 39 were female (47.0%). The mean age of the patients was 32.28±16.10 years. Serum pro-ADM levels were higher in patients with appendicitis than in those without. Setting the cut-off value for pro-ADM at 3.375 pg/mL to identify patients with appendicitis revealed a statistically significant difference between patients with and without appendicitis (p=0.002). Additionally, there was a statistically significant difference in serum pro-ADM levels when comparing the duration of ED presentation among patients with appendicitis (p<0.001).
CONCLUSION: Serum pro-ADM levels are elevated in patients with appendicitis; however, pro-ADM is less effective in distinguishing between simple and complicated appendicitis. Serum pro-ADM levels in patients who present to the ED within the first 24 hours of abdominal pain onset may be useful for early diagnosis.

Keywords: Acute abdominal pain, acute appendicitis, emergency department, biomarker, pro-adrenomedullin.