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

Abstract

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.

Clinical Value of Procalcitonin in Patients with Spinal Infection

“…The early detection of infection is important in both physiologic and clinical aspects. The earlier a damaged tissue can be confirmed, the earlier preventive and therapeutic treatment can be initiated 15) . CRP, ESR, and WBC counts are the laboratory parameters of infectious diseases in making diagnosis and assuring the treatment response.…”

“…Above these studies, Chung et al 1) reported the usefulness of PCT in the diagnosing of neurosurgical patients with postoperative fever of unknown origin. Nie et al 15) reported that PCT is more reliable marker for the early prediction of postoperative infectious complication in patients with acute traumatic spinal cord injury. Many articles have published about the usefulness of PCT 3 9 10 14 16 19 20 21) , but the study about the clinical value of PCT in spinal infection patients is rare.…”

Admission inflammatory markers and isolation of a causative organism in patients with spontaneous spinal infection

“…Several authors have considered various laboratory parameters in the detection and monitoring of early surgical site infection after spinal surgery including C-reactive protein levels, [8][9][10] procalcitonin, 11,12 and granulocyte elastase. 13 To our knowledge, no data exist detailing the prognostic significance of the admission inflammatory marker levels on aiding the detection and diagnosis of spontaneous spinal infection.…”

C-Reactive Protein in Diabetic Patients Before Gastric Bypass as a Possible Marker for Postoperative Complication

“…In a non-randomized prospective cohort study published in 2011, levels of procalcitonin were examined as a possible prognostic parameter for infectious complications in patients with acute spinal cord lesions with and without postoperative infection. The patients who experienced complications (7.7%) had significantly higher levels of procalcitonin and CRP compared to those without complications, with procalcitonin being more sensitive than CRP 16 .…”