Predictive value of procalcitonin for early abdominal infection after pancreatoduodenectomy

Abstract

Objective To evaluate the early predictive and diagnostic value of procalcitonin (PCT) in abdominal infection after pancreatoduodenectomy(PD). Methods The clinical data of 62 patients with PD in the First Affiliated Hospital of Harbin Medical University from April 2016 to April 2017 were retrospectively analyzed. The general data and postoperative conditions of the patients were recorded. Serum PCT, C-reactive protein (CRP) levels and WBC counts were measured before and 1, 3, and 5 days after surgery. According to the postoperative abdominal infection, the patients were divided into abdominal infection group(n=10) and control group(n=52). The area under the ROC curve(AUC) was calculated by plotting the receiver operating characteristic (ROC) curve, and the cut-off value was determined to compare the sensitivity and specificity of the two groups of patients. Results There were no significant difference between two groups on age, gender, BMI, diabetes mellitus, preoperative laboratory indicators, anesthetic time, operation time, intraoperative bleeding and blood transfusion, surgical procedures and Braun anastomosis, which were comparable. The incidence of postoperative hyperglycemia, surgical incision infection, pancreatic fistula, biliary fistula, mortality, postoperative hospital stay and total medical costs of abdominal infection group were significantly higher than those of control group (P<0.05). There were no significant differences on PCT, CRP, and WBC between the two groups before surgery. The PCT level of the abdominal infection group was significantly higher than that of the control group at the 1st postoperative day and the difference was statistically significant (P<0.05). The sensitivity of predicting abdominal infection was 90% and the specificity was 75%, which was significantly higher than those of CRP and WBC. There were no significant differences on the sensitivity and specificity of PCT, CRP and WBC for postoperative abdominal infection at 3 and 5 days after surgery, but the sensitivity of the combined diagnosis was as high as 100% and 90%, significantly higher than 3 indicators alone, respectively. Conclusions Serum PCT level may predict in advance or diagnose early abdominal infection after PD. The combination of PCT, CRP and WBC might be more valuable for the diagnosis of abdominal infection after PD. Key words: Procalcitonin; Pancreatoduodenectomy; Surgical wound infection; C-reactive protein