Predictive value of procalcitonin for bowel ischemia and necrosis in bowel obstruction

Markogiannakis, Haridimos; Memos, Nikolaos; Messaris, Evangelos; Dardamanis, Dimitrios; Larentzakis, Andreas; Papanikolaou, D.; Zografos, George; Manouras, Andreas

doi:10.1016/j.surg.2010.08.007

Cited by 71 publications

(50 citation statements)

References 35 publications

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“…The I-FABP can be increased with dynamic recycling of enterocytes during ischemia or strangulation, but I-FABP measurement requires a long period of time, while measurement of serum CRP and serum D-lactate can be done in a short span of time. Another study evaluating procalcitonin 35 as a marker for strangulation in cases of acute small bowel obstruction found it to have a PPV of 95% and an NPV of 90%. However, the results of this study should be taken into account along with the possibility of bacterial translocation occurring in cases of intestinal obstruction without strangulation resulting in false elevation of procalcitonin.…”

Section: Discussionmentioning

confidence: 99%

Combination of Serum C-reactive Protein and D-lactate: Predictors of Strangulation in Intestinal Obstruction

Pal¹,

Ansari²,

Islam³

2016

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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Introduction: Serum C-reactive protein (CRP) and D-lactate have been proposed as markers of intestinal ischemia. The purpose of this prospective observational study is to find whether serum CRP and serum D-lactate can help in predicting strangulation in cases of acute intestinal obstruction. Materials and methods:A total of 50 consecutive patients were included in the study after excluding patients of comorbid medical illness and patients with findings other than obstruction or strangulation. The serum values of CRP and D-lactate were measured and compared between obstruction with strangulation and obstruction without strangulation. Receiver operating characteristic (ROC) curve was drawn and cutoff values for the diagnosis of strangulation were calculated along with calculation of sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs).Results: A total of 14 patients who were diagnosed with strangulated bowel obstruction had significantly higher values of serum CRP and D-lactate when compared with 36 patients with simple bowel obstruction (116 vs 40 mg/L and 5.4 vs 2.7 mmol/L respectively, p < 0.05). Using ROC analysis, the area under the curve of serum CRP and D-lactate was found to be 0.785 and 0.775 respectively, for bowel strangulation. Using a cutoff value of 60 mg/L for CRP, the sensitivity, specificity, PPV, and NPV were 87.5, 58.3, 48.3, 91.3% respectively. Using a cutoff value of 4.5 mmol/L for D-lactate, the sensitivity, specificity, PPV, and NPV were 75.0, 69.4, 52.7, 86.2% respectively. Conclusion:Serum CRP and D-lactate can be useful and reasonable markers for predicting strangulation in cases of acute intestinal obstruction in an emergency setting.

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Section: Discussionmentioning

confidence: 99%

Combination of Serum C-reactive Protein and D-lactate: Predictors of Strangulation in Intestinal Obstruction

Pal¹,

Ansari²,

Islam³

2016

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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“…Nagata et al [36] Open aortic surgery 93 < 0.5 -> 10 Immunochromatographic test Markogiannakis et al [22] Small and large bowel obstruction 242 4.89-14.35 LUMItest Cosse et al [23] Small bowel obstruction 166 0.29-2.03 Kryptor TRACE Cosse et al [37] Small bowel obstruction 59 0.06-8.1 Kryptor TRACE Cosse et al [38] Ischemic disease (ischemic colitis and mesenteric infarction) 99 0.217-621.2 Kryptor TRACE Table 3 Diagnostic utility of procalcitonin for the diagnosis of intestinal ischemia clinical trial [23] . We reported that when measured with the Kryptor TRACE method, the PCT values ranged from 0.29 ng/mL to 2.03 ng/mL in patients with ischemia.…”

Section: Assay Methodsmentioning

confidence: 99%

“…The PCT levels were assayed using an immunochromatographic method and ranged from below 0.5 ng/mL in patients without ischemia to > 10 ng/mL in patients with ischemia. In 2011, Markogiannakis et al [22] suggested that PCT could be used as a diagnostic tool for ischemia and necrosis on the basis of their study of 242 patients treated for small or large bowel obstruction due to various aetiologies. According to the LUMItest, the PCT levels in patients with ischemia or necrosis ranged from 4.89 ng/mL to 14.35 ng/mL.…”

Section: Clinical Datamentioning

confidence: 99%

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Procalcitonin and intestinal ischemia: A review of the literature

Cossé¹,

Sabbagh²,

Kamel³

et al. 2014

WJG

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Intestinal ischemia is common after emergency gastrointestinal or cardiovascular surgery. At present, there are no diagnostic tools for the early diagnosis of intestinal ischemia. In the last decade, procalcitonin (PCT) has been suggested as a marker of this condition. Here, we review the use of PCT as a diagnostic tool for intestinal ischemia. Two reviewers independently searched the PubMed and EMBASE databases for articles on intestinal ischemia and PCT. They then considered (1) the criteria applicable to preclinical and clinical data; and (2) PCT's predictive value in the diagnosis of intestinal ischemia. Article quality was rated according to the STAndards for Reporting of Diagnostic accuracy. Between 1993 and 2014, seven studies (including two preclinical studies and five clinical studies) dealt with the use of PCT to diagnose intestinal ischemia. Procalcitonin's sensitivity, specificity, positive predictive value and negative predictive value ranged between 72% and 100%; 68% and 91%; 27% and 90% and 81% and 100%, respectively. The area under the receiver operating characteristic curve ranged from 0.77 to 0.92. In view of the preclinical and clinical data, we consider that PCT can be used in daily practice as a tool for diagnosing intestinal ischemia.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Procalcitonin; Intestinal; Ischemia; Diagnosis; Review Core tip: The serum procalcitonin level is clinically relevant for the diagnosis of intestinal ischemia. In the diagnosis of intestinal ischemia, procalcitonin's sensitivity is greater than 70% and its negative predictive value is greater than 80%.

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“…Другие клиницисты [10,11] предлагают в качестве независимого предиктора ишемии кишечника опираться на показатели прокаль-цитонина: его увеличение в крови более 9 нг/ мл свидетельствует о критической ишемии кишечной стенки. В исследованиях на мышах R.G.…”

Section: диагностика синдрома кишечной недостаточностиunclassified

Diagnosis and Treatment of Syndrome of Intestinal Insufficiency in Acute Bleeding from Upper Gastrointestinal Tract

Климович¹,

Maskin²,

Abpamov³

2017

Novosti Khirurgii

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Острая массивная кровопотеря из гастродуоденальной зоны приводит к развитию синдрома кишечной недостаточности (СКН) вследствие ишемических и последующих реперфузионных повреждений стенки кишечника. Нарушение барьерных функций стенки кишки обусловливает массивное поступление внутрикишечных токсинов в портальный кровоток и кишечный лимфа-тический коллектор и служит триггером формирования полиорганной недостаточности. Вслед-ствие чего остро возникают вопросы ранней диагностики развития СКН, которые в настоящее время представляют широкую гамму инвазивных биохимических исследований, изучение мио-электрических параметров и данных сонографии. Однако учитывая сложный, разносторонний характер патогенеза кишечной недостаточности, чрезвычайно трудно выделить из них наиболее информативные. На сегодняшний день в клинической практике установленной стратегии лече-ния СКН при желудочно-кишечных кровотечениях (ЖКК) нет. Основные направления терапии СКН ограничиваются интраинтестинальной детоксикацией и коррекцией окислительного стресса. Это объясняет большое количество экспериментальных работ, в которых при моделировании геморрагической гипотензии и ишемически-реперфузионных поражений кишечника, изучаются возможности поддержки его секреторной и кинетической функций, коррекции метаболических нарушений и регенерирующих механизмов, усиления антиоксидантных и противовоспалительных способностей. Тем не менее, несмотря на большой арсенал экспериментальных и клинических исследований, вопросы ранней диагностики и этиопатогенетического лечения СКН далеки от разрешения и требуют дальнейшего изучения.Ключевые слова: синдром кишечной недостаточности, желудочно-кишечное кровотечение, ишемия-репер-фузия, диагностика кишечной недостаточности, лечение кишечной недостаточности, стенка кишки Acute massive bleeding from the gastroduodenal zone leads to the development of the syndrome of intestinal insufficiency (SII), due to ischemia/reperfusion injury of the intestinal wall. Violation of the barrier functions of the intestinal wall causes a massive inflow of the toxins from the intestine to the portal circulation and intestinal lymphatic collector that triggers multiple organ failure. As a result the issue of early diagnosis of the SII arises urgently, which currently represent a wide range of invasive biochemical studies, studying of myoelectric parameters and sonography data. However, taking into consideration the complicated, multilateral nature of the pathogenesis of intestinal insufficiency, it is extremely difficult to differentiate the most informative one. At a result, in the clinical practice there is no established strategy of SII treatment in the gastrointestinal bleeding (GIB). The main tendencies of SII therapy are limited by intraintestinal detoxification and correction of oxidative stress. This explains a large number of experimental studies in which using the modeling of hemorrhagic hypotension and intestinal ischemia/reperfusion lesions, the possibilities of supporting its secretory and kinetic functions, the correction of metabo...

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Predictive value of procalcitonin for bowel ischemia and necrosis in bowel obstruction

Cited by 71 publications

References 35 publications

Combination of Serum C-reactive Protein and D-lactate: Predictors of Strangulation in Intestinal Obstruction

Combination of Serum C-reactive Protein and D-lactate: Predictors of Strangulation in Intestinal Obstruction

Procalcitonin and intestinal ischemia: A review of the literature

Diagnosis and Treatment of Syndrome of Intestinal Insufficiency in Acute Bleeding from Upper Gastrointestinal Tract

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