Value of procalcitonin in differentiating post-surgical systemic and infectious complications from inflammatory reaction caused by surgical trauma in fracture surgery: preliminary report

Abstract

Effect of fracture itself and fracture surgery to serum procalcitonin levels and the value of procalcitonin in differentiating inflammatory reaction caused by fracture surgery from post-surgical complications were investigated in this study. Twenty-nine patients over 50 years old who underwent surgery for hip fractures were evaluated. Procalcitonin, C-reactive protein, white blood cell count and body temperature were measured before surgery and for 5 days postoperatively. Preoperatively, procalcitonin levels were lower than the normal in all patients. It made a peak on the first postoperative day without exceeding the normal range and returned to preoperative level on the fifth day. In contrast to C-reactive protein, which was above the normal in all patients, procalcitonin levels were higher than the normal only in patients with systemic and infectious complications. Procalcitonin seems to be much superior to other infection parameters based on the fact that it is not affected by inflammatory response resulting from fracture itself and fracture surgery, it provides a faster response to surgical trauma, it declines more rapidly after removal of the factor leading to the inflammatory response, it follows a standard postoperative kinetics. It has to be a warning sign for systemic and infectious complications, when postoperative procalcitonin levels have been above 0.5 ng/ml.