Value of CA-125 Glycoprotein in Predicting Acute Appendicitis; a Diagnostic Accuracy Study
Archives of Academic Emergency Medicine,
Vol. 7 No. 1 (2019),
1 Dey 2019
,
Page e24
https://doi.org/10.22037/aaem.v7i1.356
Abstract
Introduction: Carcinogen antigen 125 (CA-125) is a glycoprotein antigen, which has shown potentials in predicting peritoneal inflammation. The aim of this study is to determine the value of CA-125 in predicting acute appendicitis (AA).
Methods: This prospective diagnostic accuracy study was conducted on 15 – 70 year-old patients with acute abdominal pain, suspected to AA, referred to emergency department. The serum level of CA-125 was measured for all patients before appendectomy and its screening characteristics in detection of AA case (confirmed by histology findings) were calculated and reported with 95% confidence interval (CI).
Results: 95 patients with the mean age of 31.65 ± 12.9 (15-75) years were studied (54.3% male). Based on the histologic findings, 72 (75.8%) cases were categorized as AA (23 cases as severe). AA and non-AA (NAA) groups were similar regarding the mean age (p = 0.59), mean duration of symptoms (p = 0.08), mean white blood cell (WBC) count (p = 0.37), and mean PMN percentage (p = 0.55).  Mean CA-125 level was 16.5 ± 20.0 U/mL in the AA group and 30.5 ± 6.1 U/mL in the NAA group (p = 0.001). Adjustment of analysis based on gender revealed a significant correlation between CA-125 level and diagnosis of AA only in females (34.23 ± 39 U/mL in NAA versus 20.7 ± 26.7 U/mL in AA, p = 0.012). The area under the ROC curve of CA-125 was 0.62 (95%CI: 0.51 to 0.72). Sensitivity, specificity, NPV, PPV, NLR, and PLR of CA-125 in 16.4 U/mL cut off (best point) were 77.8% (95%CI: 66.4 - 86.7), 50.0% (95%CI: 28.2 - 71.8), 83.6% (95%CI: 76.7 - 88.7), and 40.7% (95%CI: 27.4 - 55.6), 0.44 (95%CI 0.2 - 0.8), and 1.56 (95%CI: 1.0 - 2.4), respectively.
Conclusion: Considering the lower levels of CA-125 in patients with AA compared with NAA cases and also weak screening performance characteristics, it seems that it could not be considered as an accurate screening tool in this regard.
- Appendix
- appendicitis
- CA-125 antigen
- biomarkers
- abdominal pain
How to Cite
References
Chamisa I. A clinicopathological review of 324 appendices removed for acute appendicitis in Durban, South Africa: a retrospective analysis. The Annals of The Royal College of Surgeons of England. 2009;91(8):688-92.
Ricci M, Trevisani M, Beck W. Acute appendicitis. A 5-year review. The American surgeon. 1991;57(5):301-5.
Stringer MD. Acute appendicitis. Journal of paediatrics and child health. 2017;53(11):1071-6.
Omundsen M, Dennett E. Delay to appendicectomy and associated morbidity: a retrospective review. ANZ journal of surgery. 2006;76(3):153-5.
Christian F, Christian G. A simple scoring system to reduce the negative appendicectomy rate. Annals of the Royal College of Surgeons of England. 1992;74(4):281.
Benito J, Acedo Y, Medrano L, Barcena E, Garay RP, Arri EA. Usefulness of new and traditional serum biomarkers in children with suspected appendicitis. The American journal of emergency medicine. 2016;34(5):871-6.
Acar E, Özcan Ö, Deliktaş H, Beydilli H, Kırlı İ, Alataş ÖD, et al. Laboratory markers has many valuable parameters in the discrimination between acute appendicitis and renal colic. Turkish Journal of Trauma and Emergency Surgery. 2016;22(1):17-22.
Atema JJ, Gans SL, Beenen LF, Toorenvliet BR, Laurell H, Stoker J, et al. Accuracy of white blood cell count and Câ€reactive protein levels related to duration of symptoms in patients suspected of acute appendicitis. Academic Emergency Medicine. 2015;22(9):1015-24.
Assarsson J, Körner U, Lundholm K. Evaluation of procalcitonin as a marker to predict antibiotic response in adult patients with acute appendicitis: a prospective observational study. Surgical infections. 2014;15(5):601-5.
Bilgic I, Durdu T, Gelecek S, Yorulmaz S, Karakilic E, Ozmen MM, et al. CA-125 as a marker of peritoneal inflammation in diagnosis of acute appendicitis. Int J Multidiscip Res Dev. 2015;2(3):240-3.
Sevinç B, Turan E, Kurku H, Karahan Ö. Role of CA125 in the Diagnosis of Acute Appendicitis. Journal of Academic Emergency Medicine. 2017;16(2):62.
Berger Y, Nevler A, Shwaartz C, Lahat E, Zmora O, Gutman M, et al. Elevations of serum CAâ€125 predict severity of acute appendicitis in males. ANZ journal of surgery. 2016;86(4):260-3.
Allister L, Bachur R, Glickman J, Horwitz B. Serum markers in acute appendicitis. Journal of Surgical Research. 2011;168(1):70-5.
Kwan KY, Nager AL. Diagnosing pediatric appendicitis: usefulness of laboratory markers. The American journal of emergency medicine. 2010;28(9):1009-15.
Basaran A. CAâ€125 for diagnosis of acute appendicitis: New possibility for an old tumor marker. Colorectal Disease. 2010;12(2):155-6.
Zeimet AG, Marth C, Offner FA, Obrist P, Uhl-Steidl M, Feichtinger H, et al. Human peritoneal mesothelial cells are more potent than ovarian cancer cells in producing tumor marker CA-125. Gynecologic oncology. 1996;62(3):384-9.
Zeillemaker A, Verbrugh H, Van Papendrecht AH, Leguit P. CA 125 secretion by peritoneal mesothelial cells. Journal of clinical pathology. 1994;47(3):263-5.
Çetinkaya E, Erdoğan A, Akgül Ö, Çelik C, Tez M. High serum cancer antigen 125 level indicates perforation in acute appendicitis. The American journal of emergency medicine. 2015;33(10):1465-7.
- Abstract Viewed: 544 times
- PDF Downloaded: 332 times
- HTML Downloaded: 68 times
Download Statastics
Make a Submission
SJR
COPE
