Procalcitonin in Early Detection of Postoperative Infectious Complications. the Comparison with a Set of Cytokines, Soluble Cytokine Receptors and Acute Phase Proteins

Abstract

Background: Infections and sepsis are relevant complications in patients undergoing large abdominal surgery and still constitute a diagnostic challenge. Only limited markers can differentiate incipient postoperative sepsis from uncomplicated early postoperative reaction. A prospective clinical study was performed to examine the accuracy of procalcitonin (PCT), set of cytokines, soluble cytokine receptors and acute phase proteins in patients following major abdominal surgery. Subjects and Methods: Between January 2006 and February 2008, 48 patients with febrile episode of the early postoperative period after abdominal surgery were entered into the study. Blood samples were obtained on the first day of fever for the measurement of plasma PCT (Kryptor), TNFalpha, IL-1beta, IL-1ra, IL-2, IL-6, sIL-6R, IL-8 (ELISA), and 10 acute phase proteins (nephelometry). Data were compared with reference group: 24 patients with the planned resection of colorectal cancer at stage Ib-IV and uncomplicated healing; venous blood samples were obtained repeatedly before surgery, 6, 12, 18, 24, 48, and 72 h after start of surgery Results: Febrile reaction of 26/48 patients was linked with positive blood culture results. PCT and IL-6 concentrations of blood culture positive subjects differed significantly from non-bacteremic patients (p < 0.01 for both parameters) as well as from uncomplicated patients (p < 0.003 and p < 0.001). Cutoff levels to distinguish blood culture positive and negative subgroups using ROC were 0.96 ng/ml for PCT and 345 pg/ml for IL-6. Other inflammatory parameters showed high sensitivity but lower specificity for bacterial complications in relation to uncomplicated postsurgical course. PCT and monitored cytokines culminated 18—36 h following uncomplicated surgery and postoperative PCT levels did not exceed 1.02 ng/ml in this group Conclusions: Simultaneous PCT and IL-6 examination is a reliable approach to distinguish incipient infectious complications in early postoperative period. Their measurement is well founded for daily monitoring of high-risk patients after large abdominal surgical procedures. Supported with grant IGA-MZ-CR-4825—3.