Serum procalcitonin levels are elevated in esophageal cancer patients with postoperative infectious complications.
ABSTRACT The normal systemic inflammatory response to surgical stimuli often makes early diagnosis of postoperative infections difficult.
We investigated whether serum procalcitonin (PCT) levels may be a useful marker of bacterial infections in patients after invasive surgery.
The subjects were 40 patients who had undergone radical surgery for esophageal carcinoma by a right thoracoabdominal approach. Nine patients were diagnosed to have a postoperative infection during the first 7 days after surgery. Changes in serum PCT levels were compared between the group diagnosed to have postoperative infection (infection group) and the group without infection (noninfection group).
The postoperative serum PCT levels were significantly higher in the infection group than in the noninfection group (ANOVA: p < 0.01). Serum PCT peaked on postoperative day (POD) 5 in the infection group (8.7 +/- 8.2 ng/ml, mean +/- SD) and on POD 1 in the noninfection group (0.5 +/- 0.5 ng/ml). No significant differences were found between the two groups in leukocyte count, serum CRP or cytokine levels. The receiver operating characteristics (ROC) curve was constructed for infection identification. The area under the ROC curve for peak postoperative PCT was 0.968, and at a cutoff value of 2.0 ng/ml, the sensitivity was 89% and the specificity was 93%.
Serum PCT levels may be useful for the early diagnosis of postoperative infectious complications.
Article: A brief history of procalcitonin.[show abstract] [hide abstract]
ABSTRACT: During the last decade our group at the Institute G. Roussy was studying tumor markers. We were particularly interested in calcitonin (CT), an excellent marker for medullary thyroid cancer (MTC). In order to obtain a highly specific and sensitive assay for CT, we decided to produce monoclonal antibodies (Mabs) against its moieties. We then successfully developed a highly sensitive and specific assay for CT. During this time, however, we also produced a library of Mabs which not only recognized CT but also procalcitonin (PCT) and the N or C terminal of calcitonin precursor molecules, calcitonin glycine (CTG) and katacalcin (KC). A major problem was the lack of pure PCT, essential for standardization of assays. At that time, procalcitonin could be produced in small amounts by a very difficult synthesis process. Fortunately, we found that PTN 47, a peptide of 47 amino acids could be successfully used as a standard instead of procalcitonin. This peptide contains two epitopes which react with Mabs against KC and CT in the same manner as PCT does. Equipped with this new and standardized radioimmunometric assay, we not only studied patients with MTC but also patients suffering from other malignant and non-malignant diseases. We noted that PCT levels were specially increased in patients with small cell carcinoma of the lung. This suggested that the neuroendocrine cells of the lungs were a probable site of PCT production.European Journal of Intensive Care Medicine 02/2000; 26 Suppl 2:S146-7. · 5.17 Impact Factor
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ABSTRACT: To describe the initial evolution of serum procalcitonin (PCT) and C-reactive protein (CRP) in previously healthy adult trauma patients and to compare the relationship of the expression of these two proteins with indicators of trauma severity. Prospective, descriptive, longitudinal study. Surgical ICU in an university hospital. Twenty-one patients admitted during the first posttraumatic 3 h exhibiting an Injury Severity Score (ISS) between 16 and 50 were enrolled. Blood sampling was performed on admission and on posttraumatic days 0.5, 1, 2 and 3 to assess serum levels of PCT and CRP. Total creatine kinase (CKtot) and lactate dehydrogenase (LDHtot) activities in the serum were used as tissue damage indicators. PCT exhibited an early and transient increase in serum levels similar to a more delayed change of CRP levels. Peak PCT and peak CRP were related to the ISS, the extent of tissue damage and the amount of fluid replacement during the first day. During the first 3 posttraumatic days, 90% of the patients exhibited a generalized inflammatory syndrome without infection. An early and transient release of PCT into the circulation was observed after severe trauma and the amount of circulating PCT seemed proportional to the severity of tissue injury and hypovolemia, yet unrelated to infection. The predictive value of both PCT and CRP for a forthcoming multiple organ failure still remains to be clarified.Intensive Care Medicine 02/1998; 24(2):185-8. · 5.26 Impact Factor
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ABSTRACT: Procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations were measured after different types of surgery to analyze a possible postoperative induction of procalcitonin (PCT), which might interfere with the diagnosis of bacterial infection or sepsis by PCT. PCT and CRP plasma levels as well as clinical symptoms of infection were prospectively registered preoperatively and 5 days postoperatively. University hospital, in-patient postoperative care. Hundred thirty patients were followed up; 117 patients with a normal postoperative course were statistically analyzed. Interventions: None. PCT concentrations were moderately increased above the normal range in 32 % of patients after minor and aseptic surgery, in 59 % after cardiac and thoracic surgery, and in 95 % of patients after surgery of the intestine. In patients with an abnormal postoperative course, PCT was increased in 12 of 13 patients. CRP was increased in almost all patients. Postoperative induction of PCT largely depends on the type of surgery. Intestinal surgery and major operations more often increase PCT, whereas it is normal in the majority of patients after minor and primarily aseptic surgery. PCT can thus be used postoperatively for diagnostic means only when the range of PCT concentrations during the normal course of a certain type of surgery is considered and concentrations are followed up.Intensive Care Medicine 08/1998; 24(7):680-4. · 5.26 Impact Factor