Normal behavior of plasma procalcitonin in adolescents undergoing surgery for scoliosis

Abstract

Background and Aims: surgical site infections are relatively common after spinal deformity surgery. early detection of deep wound infections is important, since it may allow retention of spinal instrumentation. however, serum c-reactive protein and erythrocyte sedimentation rate may remain elevated for almost 6 weeks, making differential diagnosis of systemic inflammatory response and acute deep bacterial wound infection difficult. Plasma procalcitonin has been suggested to be a useful indicator for bacterial infection. however, there are no studies evaluating behavior of procalcitonin in patients undergoing major spine surgery with instrumentation.Materials and Methods: a total of 50 consecutive adolescents (37 idiopathic scoliosis and 13 neuromuscular scoliosis, mean age = 15 years at surgery and follow-up time = 21 months (range = 12-29 months)) undergoing scoliosis surgery participated in this prospective follow-up study. White blood cell count, serum c-reactive protein, and plasma procalcitonin levels were measured on the day before surgery, on the day of surgery, and daily thereafter for 1 week. None of the patients developed signs of acute or delayed wound infection during the follow-up period; however, two neuromuscular scoliosis patients developed severe postoperative pneumonia, and their inflammatory parameter data will be reported separately.Results: Plasma procalcitonin levels peaked on the first postoperative day (mean = 0.19 ng/ml, range = 0.04-1.29 ng/ml), and mean values were less than 0.5 ng/ml during the whole first postoperative week, while c-reactive protein remained elevated during the whole first postoperative week (highest mean value = 63.8 mg/l (range = 5-248 mg/l) on third postoperative day). Patients with idiopathic scoliosis had lower c-reactive protein levels (p < 0.05 from first to sixth postoperative day) and lower procalcitonin levels (p < 0.05 from third to seventh postoperative day) than neuromuscular scoliosis patients. two

Is procalcitonin increased in cases of invasive amoebiasis? A retrospective, observational study

“…However, it was not easy to distinguish the role of this patient's amoebic liver abscess from his underlying disease. As it has been reported in cases of bacterial sepsis (de Azevedo et al, 2012;Prkno et al, 2013;Wacker et al, 2013), the mean PCT level in our study (4.03 μg/L) was well above the threshold of 0.50 μg/L that is sometimes used in practice (Al-Dorzi HM et al, 2014;Syvanen J et al, 2014) for distinguishing between bacterial infection and viral disease (Piacentini et al, 2011) or other causes of unspecific inflammation (Anand et al, 2015;Tsalik et al, 2012). However, it is worth noting that individual values appeared heterogeneous and were globally lower than the rates observed during bacterial sepsis (de Azevedo et al, 2012;Prkno et al, 2013;Wacker et al, 2013).…”

“…The assay was retrospective and monocentric and was performed once. A normal PCT value was expected to be below 0.06 μg/L (Syvanen et al, 2014), whilst the cutoff for sepsis was established at 0.50 μg/mL (Al-Dorzi et al, 2014), according to the manufacturer's recommendations (http://www.procalcitonin.com/). C-reactive protein (CRP) was measured using rabbit anti-CRP antibodies coated on latex particles (CRP Latex reagent® on the AU2700®; Beckman Coulter, Pasadena, CA, USA).…”

Updating the Evidence: Systematic Literature Review of Risk Factors and Strategies for Prevention, Diagnosis, and Treatment of Surgical Site Infection After Pediatric Scoliosis Surgery

“…One Level II prospective study found that serum CRP levels peaked on the third postoperative day [6.38 mg/dL (range, 0.5-24.8)] but remained elevated during the first week, and AIS patients had lower CRP levels than NMS patients. However, none of these patients developed SSI 80 . In a cohort of AIS patients, 1 Level IV study reported that CRP levels peaked on postoperative day 2 for patients who did [mean 5.8 mg/dL (3.4to 9.8)] and did not [mean 8.0 mg/dL (range, 0.2 to 14.4)] develop wound infection, but patients with early SSI had a second peak [mean 6.5 mg/dL (4.6 to 8.2)] on day 7 81 .…”

“…However, none of these patients developed SSI. 80 In a cohort of AIS patients, 1 Level IV study reported that CRP levels peaked on postoperative day 2 for patients who did [mean 5.8 mg/dL (3.4to 9.8)] and did not [mean 8.0 mg/dL (range, 0.2 to 14.4)] develop wound infection, but patients with early SSI had a second peak [mean 6.5 mg/dL (4.6 to 8.2)] on day 7. 81 ESR levels, however, did not differ between patients with SSI and those without wound complications.…”

Postoperative Spinal Implant Infections (PSII)—A Systematic Review: What Do We Know So Far and What is Critical About It?

“… 30 , 31 Procalcitonin, ESR and a leukocytosis might be alternative diagnostical tools, although their predictive value specifically in the context of PSII has not systematically determined yet. 32 Blood cultures should be taken in any patients showing signs of systemic infections or sepsis. 33 An MRI with Gadolinium enhancement is the gold standard for imaging in suspected PSII, and might show epidural fluid collections, bone destructions and marrow inhomogeneity.…”