Elevated Carboxyterminal Propeptide of Fibrinogen accurate diagnostic Marker in Acute Appendicitis: Study
Researchers have found in a new study that carboxyterminal propeptide of fibrinogen (CFP) levels are elevated in histologically confirmed acute appendicitis. Further this demonstrates diagnostic accuracy comparable to standard serological biomarkers.
Improved diagnostic biomarkers are required for acute appendicitis. The circulating fibrocyte percentage (CFP) is increased in inflammatory states, but has not been studied in acute appendicitis. This study aimed to determine circulating fibrocyte percentage in acute appendicitis and compare diagnostic accuracy with standard serological biomarkers. A prospective cohort study was carried out between June 2015 and February 2016 at University Hospital Limerick.
The circulating fibrocyte percentage was determined by dual-staining peripheral venous samples for CD45 and collagen I using fluorescence-activated cell sorting, and correlated with histopathological diagnoses. The accuracy of circulating fibrocyte percentage in determining histological acute appendicitis was characterized and compared with the white cell count, C-reactive protein concentration, neutrophil count, lymphocyte count and neutrophil : lymphocyte ratio.
Results: Of 95 adults recruited, 15 were healthy individuals and 80 had suspected appendicitis at presentation. Forty-six of these 80 patients had an appendicectomy, of whom 34 had histologically confirmed appendicitis. The circulating fibrocyte percentage was statistically higher in patients with pathologically proven acute appendicitis than in healthy controls (median 6·1 (i.q.r. 1·6–11·6) versus 2·3 (0·9–3·4) per cent respectively; P = 0·008). The diagnostic accuracy of circulating fibrocyte percentage, as determined using the area under the receiver operating characteristic (ROC) curve, was similar to that of standard biomarkers. In multinomial regression analysis, only raised circulating fibrocyte percentage was retained as an independent prognostic determinant of acute appendicitis (odds ratio 1·57, 95 per cent c.i. 1·05 to 2·33; P = 0·027). The circulating fibrocyte percentage is increased in histologically confirmed acute appendicitis and is as accurate as standard serological biomarkers in terms of diagnosis.
Reference:
Zarog, M.A., O'Leary, D.P., Kiernan, M.G., Bolger, J., Tibbitts, P., Coffey, S.N., Lowery, A., Byrnes, G.J., Peirce, C., Dunne, C.P. and Coffey, J.C. (2020), Role of circulating fibrocytes in the diagnosis of acute appendicitis. BJS Open, 4: 1256-1265. https://doi.org/10.1002/bjs5.50350
