Diagnostic accuracy of elevated pro-calcitonin for predicting mortality in patients undergoing surgery for mechanical small bowel obstruction keeping actual mortality as gold standard.

Abstract

Objective: To assess the diagnostic accuracy of high procalcitonin levels in predicting death among patients having surgery for mechanical small intestinal obstruction, using actual mortality as the gold standard. Study Design: Cross-sectional Validation study. Setting: Departments of Medicine and Surgery at KRL Hospital, Islamabad. Period: October 2023 to June 2024. Methods: After receiving approval from the institutional ethical review committee. Patients who provided consent and met the inclusion criteria were included from the medical and surgical units of KRL Hospital, Islamabad. Patients were evaluated upon admission by a researcher under the supervision of a specialist. Blood samples (5–10 mL) were obtained for PCT assessment. Patients were monitored for 14 days, with any fatalities recorded as mortality. Results: In this study of 203 participants, the mean age was 47.44±10.56 years, with a mean hospital stay of 13.51±2.13 days and a mean PCT level of 11.09±0.75 ng/mL. PCT levels ≥0.65 ng/mL were found in 88.7% of participants, while 11.3% had levels <0.65 ng/mL. The in-hospital mortality rate was 2.0%. The PCT threshold of 0.65 ng/mL had a sensitivity of 25%, specificity of 89%, PPV of 4.35%, and NPV of 98.33%. Conclusion: Elevated PCT levels are a useful biomarker for predicting mortality in mechanical SBO surgery due to high specificity. However, low sensitivity mean PCT should be combined with other diagnostic methods.