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.
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ABSTRACT: The goal of the study was to evaluate the specificity of serum procalcitonin (PCT) in a large cohort of patients with solid carcinomas at different stages. The study involved 447 patients having histologically confirmed carcinoma of the breast, head and neck, ovary, cervix or non-small cell lung carcinoma. Patients with a history of small cell lung cancer, neuroendocrine tumors, medullary thyroid carcinoma, sepsis, systemic inflammatory syndrome, renal failure and/or serum C-reactive protein above 5 ng/mL were excluded. Additionally, those with suspicious infectious or inflammatory diseases in (18)F-fluorodeoxyglucose positron-emission tomography/computed tomography were also excluded. Serum PCT concentrations were measured using a Kryptor system (BRAHMS) and a clinical cut-off at 0.5 ng/mL was used to define positive results. Serum PCT concentrations did not change at different cancer stages (Kruskal-Wallis, p>0.05). No patient had a PCT concentration >0.5 ng/mL. Our data show that solid carcinomas "per se" did not increase circulating PCT concentrations, regardless of the histotype and stage of the disease.Clinical Chemistry and Laboratory Medicine 05/2010; 48(8):1163-5. · 3.01 Impact Factor
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ABSTRACT: We evaluated postoperative concentrations of inflammatory indicators, including procalcitonin, after gynaecological operations for benign and malignant tumours in patients with a normal postoperative course and assessed the utility of procalcitonin in differentiating between non-bacterial inflammation and bacteraemic complications in the postoperative period. This prospective study included 99 patients: 47 after a standard gynaecological operation (Piver I) and no postoperative infectious complications (group 1), 35 after a major procedure (Piver II or III) and no postoperative infectious complications (group 2), and five with postoperative sepsis after Piver II or III procedures (group 3). We also studied serum procalcitonin concentrations in a group of 12 patients (group 4) with terminal forms of gynaecological cancer who were hospitalized for palliative treatment but did not undergo surgery. Postoperative C-reactive protein (CRP) concentration corresponded with extent of tissue trauma in groups 1 and 2 and was significantly lower in group 1 than group 2. Inflammatory indicators were highest in groups 1 and 2 on postoperative day 2. In group 3, in which sepsis developed, values were highest on postoperative day 4. In particular, procalcitonin was > 2 ng/ml in all patients with postoperative sepsis by postoperative day 2 but was always <or= 2 ng/ml in patients without sepsis. In contrast, high procalcitonin levels were noted in the patients in group 4 compared with group 3, with two-thirds of group 4 patients having levels > 2 ng/ml, with no signs of infection or raised CRP. It is concluded that, for early detection of postoperative infectious complications after gynaecological surgery, procalcitonin levels > 2 ng/ml are more specific than CRP.The Journal of international medical research 05/2009; 37(3):918-26. · 0.96 Impact Factor
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ABSTRACT: : Although the early diagnosis of anastomotic leak is a key point in reducing its clinical consequences, in daily practice, anastomotic leak diagnosis is often late. : The aim of this study was to determine whether procalcitonin and C-reactive protein are good predictors of anastomotic leak in colorectal surgery. : This is a prospective observational study. : This study was conducted by a specialized colorectal multidisciplinary team of a tertiary teaching hospital. : A series of 205 consecutive patients who underwent elective colorectal surgery in a specialized unit was prospectively analyzed. The following data were collected: demographic, surgical, ASA class, POSSUM, and morbidity. During the first 5 postoperative days, procalcitonin, C-reactive protein, leukocytes, platelets, and vital signs were evaluated daily. : Daily assessment of clinical variable and serological data were conducted in the first 5 postoperative days. : The primary outcome measure was the area under the curve at receiving operating characteristic curve analysis of the different variables in relation to the anastomotic leak. : Anastomotic leak was detected in 17 (8.3%) patients; 11(5.4%) of the patients had a major anastomotic leak (need for drainage or reoperation). None of the variables evaluated were shown to be reliable in the early detection of anastomotic leak, considering both minor and major (maximum area under the curve <0.80). In contrast, when considering only major anastomotic leaks, procalcitonin and C-reactive protein were reliable predictors on postoperative days 3 to 5 (p < 0.0001, area under the curve >0.80). The best combination was procalcitonin at postoperative day 5 (area under the curve = 0.86), with a cutoff of 0.31 ng/mL, resulting in a 100% sensitivity, 72% specificity, 100% negative predictive value, and 17% positive predictive value. : Only symptomatic patients were investigated to rule out anastomotic leakage. : Procalcitonin and C-reactive protein are both reliable predictors of major anastomotic leak after colorectal resection, although procalcitonin is more accurate. Raised procalcitonin and C-reactive protein serum concentration on postoperative days 3 to 5 renders necessary a careful evaluation of the patient before discharge.Diseases of the Colon & Rectum 04/2013; 56(4):475-83. · 3.34 Impact Factor