Procalcitonin level for prediction of postoperative infection in cardiac surgery

Luo

Chinese Medical Journal

et al. 2017

Background:In cardiac surgery, elevation of procalcitonin (PCT) could be observed postoperatively in the absence of any evidence of infection and also seems to be a prognostic marker. PCT levels measured in patients undergoing Type A aortic dissection (TAAD) were used to determine prognostic values for complications and surgical outcomes.Methods:Measurements of PCT, C-reactive protein (CRP), and leukocyte count were observed in TAAD surgery patients (n = 251; average age: 49.02 ± 12.83 years; 78.5% male) at presurgery (T0) and 24 h (T1), 48 h (T2), and 7 days (T3) postsurgery. PCT clearance (PCTc) on days 2 and 7 was calculated: (PCTday1 − PCTday2/day7)/PCTday1 × 100%. Endotracheal intubation duration, length of stay (LOS) in the Intensive Care Unit (ICU)/hospital, and complications were recorded.Results:PCT peaked 24 h postsurgery (median 2.73 ng/ml) before decreasing. Correlation existed between PCT levels at T1 and duration of cardiopulmonary bypass (P = 0.001, r = 0.278). Serum PCT concentrations were significantly higher in nonsurvivor and multiple organ dysfunction syndrome groups on all postoperative days. PCT levels at T1 correlated with length of time of ventilation support and ICU/hospital LOS. Comparing PCT values of survivors versus nonsurvivors, a PCT cutoff level of 5.86 ng/ml at T2 had high sensitivity (70.6%) and specificity (74.3%) in predicting in-hospital death. PCTc-day 2 and 7 were significantly higher in survivor compared with nonsurvivor patients (38% vs. 8%, P = 0.012, 83% vs. −39%, P < 0.001). A PCTc-day 7 cutoff point of 48.7% predicted survival with high sensitivity (77.8%) and specificity (81.8%).Conclusions:PCT level and PCTc after TAAD surgery might serve as early prognostic markers to predict postoperative outcome. PCT measurement may help identify high-risk patients.

Section: Discussionmentioning

confidence: 99%

Early Kinetics of Procalcitonin in Predicting Surgical Outcomes in Type A Aortic Dissection Patients

Luo

Chinese Medical Journal

et al. 2017

“…PCT continues to be investigated in several observational and interventional studies. It has been demonstrated to have good performance characteristics for the identification of bacterial infection and sepsis [2,[17][18][19][20][21]. However, the evidence on PCT guided antibiotic therapy is less forthcoming.…”

Section: Discussionmentioning

confidence: 99%

Role of repeat procalcitonin estimation at 48 hours for outcome in pregnancy associated sepsis: a prospective observational study

et al. 2021

Objectives We assessed whether repeat procalcitonin (PCT) estimation has a role in detecting organ dysfunctions and mortality in pregnancy associated sepsis (PAS). Methods The study included 85 pregnant, post-abortal, and postpartum women with PAS, diagnosed using the quick Sequential Organ Failure Assessment criteria. Median interquartile range PCT levels were documented at admission and 48 hours later. Statistical comparisons were performed between the groups with non-severe and severe (≥1 organ failure) PAS, and between the survivor and mortality groups. The relationship between PCT and the number of organ failures was also assessed. Results Most of the subjects with PAS were young and in the postpartum period (mean age 26 years; postpartum 55%). Sixteen (19%) patients died due to PAS. Sixty-two patients (74%) had severe PAS at presentation. Bacteria were isolated on culture in 64% of the subjects. PCT levels at admission were higher in patients with severe PAS than in those who did not have severe PAS. At 48 hours, this difference was significant (P=0.014; severe PAS 2.23 ng/mL vs. non-severe PAS 0.20 ng/mL). Furthermore, the number of organ failures increased at 48 hours. The PCT levels were significantly higher in the mortality group than in the survivors' group at admission (8.31 ng/mL vs. 1.72 ng/mL), and the difference increased further at 48 hours (9.54 ng/mL vs. 1.37 ng/mL). Conclusion Repeat PCT estimation at 48 hours could complement the clinical findings and enhance the prognostic value for PAS.

“…23,24 In the ICU, PCT and potentially delta PCT 25 were found to be a predictor of bacterial infection in the surgical population. 26,27 PCT was also able to predict anastomotic leaks 28 and infection after colorectal surgery 29,30 as well as mesenteric ischemia after cardiac surgery. 31 Other small outpatient and ED studies showed the diagnostic utility of PCT in identifying infection in patients with rheumatoid arthritis, 32 and differentiating erysipelas from deep vein thrombosis.…”

Section: Evidence -Observational Studies Identificationmentioning

confidence: 96%

Procalcitonin

Hamade

Huang

2020

Critical Care Clinics

112

Procalcitonin (PCT) is a protein that consists of 116 amino acids and is the peptide precursor of calcitonin. Calcitonin is initially biosynthesized as PCT which under normal conditions, is found in low levels in the circulation (≤ 0.1 ng/mL). 12 PCT was first described as a marker of bacterial infection in 1993 when high concentrations of calcitonin-like immunoreactivity were detected in the blood of patients with extra-thyroid diseases. 3 Using a monoclonal immunoradiometric assay for calcitonin precursors, investigators measured serum concentrations of procalcitonin in 79 children with bacterial and viral infections. They found serum PCT levels to be very high (6-53 ng/mL) in patients with severe invasive bacterial infections compared to patients with mild local bacterial infections or viral infections (0.1-1.5 ng/mL); additionally, they noticed PCT levels decreased rapidly during antibiotic therapy and that calcitonin levels were normal in all subjects irrespective of PCT levels. They concluded PCT levels are raised during bacterial septic conditions, and serum concentrations are correlated with severity of microbial invasion.A 1994 study also found PCT levels rise in response to bacterial infection, by injecting healthy volunteers with endotoxin and measuring serial PCT levels. 4 Levels were detectable