Procalcitonin as a prognostic and diagnostic tool for septic complications after major trauma*

Castelli, Gian Paolo; Pognani, Claudio; Cita, M; Paladini, R

doi:10.1097/ccm.0b013e31819ffd5b

Cited by 92 publications

(80 citation statements)

References 31 publications

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“…The mean values ranged from 4.3 (nonsevere sepsis) to 21.3 ng/mL (septic shock) (5,14,15) . In the present study, the median PCT values in patients with sepsis and trauma were similar to those found by Castelli et al (13) and Billeter et al (3) , respectively. Although the initial values of PCT in patients with sepsis are usually higher in more severe patients, the correlation with mortality is not as clear (5,14) .…”

Section: Discussionsupporting

confidence: 78%

“…Similar results were obtained by other researchers (12) . Castelli et al (13) also found that PCT values correlated with the severity and outcome of trauma. Moreover, in sepsis patients, particularly bacterial, initial PCT values proved to be far higher.…”

Section: Discussionmentioning

confidence: 90%

“…Only the initial value (upon ICU admission) of serum PCT was analyzed. The dynamics of PCT in patients with sepsis (5) , in postoperative care (15) , with ventilator-associated pneumonia (4) , and with trauma (3,13) prove to be more useful than the initial dosage. Heterogeneity among the non-H1N1 patients hinders comparisons between the groups.…”

Section: Discussionmentioning

confidence: 99%

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Procalcitonin in patients with influenza A (H1N1) infection and acute respiratory failure

Duarte

Bredt

et al. 2011

Einstein (São Paulo)

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Objective: To verify serum procalcitonin levels of patients with acute respiratory failure secondary to influenza A (H1N1) upon their admission to the Intensive Care Unit and to compare these results to values found in patients with sepsis and trauma admitted to the same unit. Methods: Analysis of records of patients infected with influenza A (H1N1) and respiratory failure admitted to the General Intensive Care Unit during in a period of 60 days. The values of serum procalcitonin and clinical and laboratory data were compared to those of all patients admitted with sepsis or trauma in the previous year. Results: Among patients with influenza A (H1N1) (n = 16), the median serum procalcitonin level upon admission was 0.11 ng/mL, lower than in the sepsis group (p < 0.001) and slightly lower than in trauma patients. Although the mean values were low, serum procalcitonin was a strong predictor of hospital mortality in patients with influenza A (H1N1). Conclusion: Patients with influenza A (H1N1) with severe acute respiratory failure presented with low serum procalcitonin values upon admission, although their serum levels are predictors of hospital mortality. The kinetics study of this biomarker may be a useful tool in the management of this group of patients.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Procalcitonin in patients with influenza A (H1N1) infection and acute respiratory failure

Duarte

Bredt

et al. 2011

Einstein (São Paulo)

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“…[22][23][24] In patients with a new onset of infection after a procedure, various laboratory parameters such as CRP and ESR level may be misleading as they are increased in all patients in the postoperative period and are not specific for underlying PCT as a predictor for infection after SCI surgery H Nie et al infection. 11 A trauma itself and the inflammatory reaction caused by the trauma surgery may stimulate the production of cytokine, leading to a nonspecific increase of these commonly used markers of inflammation. Thus, there is unmet need for specific markers of infection after surgical procedure.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] Nevertheless, in current clinical practice, PCT are not widely used as routine screening tests in the early postoperative period, with most surgeons relying on the leukocyte count, CRP and ESR despite evidence that these are poor diagnostic tests. 9 PCT was already used in several other studies to predict postoperative infections after several different operations, [5][6][7][8]10,11 however, the predictive value of serum PCT in detecting postoperative infectious complications in spinal cord injury patients has not been studied.…”

Section: Introductionmentioning

confidence: 99%

Procalcitonin as an early predictor of postoperative infectious complications in patients with acute traumatic spinal cord injury

Nie

Jiang

et al. 2011

Spinal Cord

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Study design: Prospective, nonrandomized, observational cohort study. Objectives: To analyze procalcitonin (PCT) level in acute traumatic spinal cord injury patients with and without postoperative infectious complications, and to determine whether PCT is a prognostic parameter of infectious complications in the early postoperative period compared with other inflammatory markers. Setting: Spine center of Chongqing, China; Trauma center of Chinese People's Liberation Army, China. Methods: A total of 339 consecutive patients with acute spinal cord injury undergone surgery were evaluated. All patients underwent measurement of leukocyte count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum PCT preoperatively and 24-48 h postoperatively. Results: In all, 26 (7.7%) of 339 participants experienced postoperative infectious complication. Patients with infection exhibited significantly higher PCT and CRP levels compared with noninfection (both Po0.01). Multivariate logistic regression analysis showed that PCT and CRP levels were independent predicators for postoperative infection. The area under the receiver operating characteristics curve of PCT and CRP were 0.82 (95% confidence intervals (CI) 0.74-0.91) and 0.68 (95%CI, 0.57-0.78), respectively. A PCT cutoff of 0.1 ng ml À1 had a reasonable sensitivity of 92% to exclude an infection and antibiotics can be initially withheld. However, in patients with PCT level above 0.5 ng ml À1 , a rapid initiation of antibiotics may be warranted. Conclusions: Serum PCT is a more reliable biologic marker for the early prediction of postoperative infectious complications in patients with acute traumatic spinal cord injury compared with CRP. PCT can early identify postoperative infections for establishing effective antibiotic therapy.

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Damage Control Orthopedics in the Polytrauma Patient

Pape¹,

Dienstknecht²,

Giannoudis

2011

External Fixation in Orthopedic Traumatology

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Procalcitonin as a prognostic and diagnostic tool for septic complications after major trauma*

Abstract: PCT plasma reinduction marks possible septic complication during systemic inflammatory response syndrome after major trauma. In addition, high PCT concentration at admission after trauma in ICU patients indicates an increased risk of septic complications.

Cited by 92 publications

References 31 publications

Procalcitonin in patients with influenza A (H1N1) infection and acute respiratory failure

Procalcitonin in patients with influenza A (H1N1) infection and acute respiratory failure

Procalcitonin as an early predictor of postoperative infectious complications in patients with acute traumatic spinal cord injury

Damage Control Orthopedics in the Polytrauma Patient

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