Diagnostic value and prognostic implications of serum procalcitonin after cardiac surgery: a systematic review of the literature

Sponholz, Christoph; Sakr, Yasser; Reinhart, Konrad; Brunkhorst, Frank M.

doi:10.1186/cc5067

Cited by 150 publications

(55 citation statements)

References 69 publications

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“…The use of serial measurements instead of a single observation reinforces the predictive power of PCT and reduces the risks of false negatives and false positives [39–43]. The same considerations are valid for the use of PCT in the investigation of suspected postoperative sepsis [44], which is currently performed after many types of surgical procedures [45–49]. …”

Section: Discussionmentioning

confidence: 99%

Procalcitonin kinetics after burn injury and burn surgery in septic and non-septic patients – a retrospective observational study

et al. 2018

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BackgroundEarly sepsis diagnosis is crucial for the correct management of burn patients, and it clearly influences outcomes. The systemic inflammatory response triggered by burns mimics sepsis presentation and complicates early sepsis diagnosis. Biomarkers were advocated to aid the diagnosis of early sepsis. Serum procalcitonin (PCT) exhibits fair accuracy and good correlation with sepsis severity, being used in diverse clinical settings. However, few studies have evaluated perioperative changes in PCT levels in burn patients. The present study evaluated PCT kinetics during the first days after burn injury and subsequent surgical interventions to assess PCT utility in distinguishing septic from non-septic inflammatory responses.MethodsThis study was a retrospective observational study of all burn patients admitted to the Coimbra Burns Unit (Portugal) between January 2011 and December 2014 who presented with a total burn surface area ≥ 15% and who underwent subsequent surgery. PCT kinetics were investigated a) during the first five days after burn injury and b) preoperatively during the five days after surgery in three subsets of patients, including those with no preoperative and no postoperative sepsis (NN), no preoperative but postoperative sepsis (NS), and preoperative and postoperative sepsis (SS). A total of 145 patients met the selection criteria and were included in the analysis.ResultsPCT levels in the first five days after burn injury were significantly higher in patients who developed at least one sepsis episode (n = 85) compared with patients who did not develop sepsis (n = 60). PCT values > 1.00 ng/mL were clearly associated with sepsis. Study participants (n = 145) underwent a total of 283 surgical interventions. Their distribution by preoperative/postoperative sepsis status was 142 (50.2%) in NN; 62 (21.9%) in NS; and 79 (27.9%) in SS. PCT values exhibited a parallel course in the three groups that peaked on the second postoperative day and returned to preoperative levels on the third day or later. The lowest PCT values were found in NN, and the highest values were observed in SS; the NS values were intermediate.ConclusionsPCT kinetics coupled with a clinical examination may be helpful for sepsis diagnosis during the first days after burn injury and burn surgery.Electronic supplementary materialThe online version of this article (10.1186/s12871-018-0585-6) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Procalcitonin kinetics after burn injury and burn surgery in septic and non-septic patients – a retrospective observational study

et al. 2018

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“…C-reaktif protein (CRP) genellikle yüksektir. Kardiyak cerrahi sonrası gelişen infeksiyonların takibinde prokalsitoninin CRP'ye üstün olduğuna ilişkin bir çalışma mevcuttur; ancak mediyastenit olgularına özel bir irdeleme yapılmamıştır (11). Mediyastenit tanısında kan kültüründe üreme olma sıklığı etkene göre değişmektedir.…”

Section: Tanıunclassified

Mediastinitis

Azap¹

2012

Klimik Dergisi

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ÖzetAkut mediyastenit nadir görülen ancak yaşamı tehdit eden bir klinik tablodur. Kardiyak cerrahideki gelişmelerden önce en sık mediyastenit nedeni, özofagus perforasyonu ve ardından orofarinksin süpüratif infeksiyonları iken; günümüzdeki en sık formu, kardiyotorasik cerrahi sonrası görülen mediyastenittir. AbstractAcute mediastinitis is a rare but life threatening clinical entity. Before the development of cardiac surgery, perforation of the esophagus was the leading cause of mediastinitis, followed by suppurative infections of the oropharynx. Currently, mediastinitis following cardiac surgery is the most common form. The clinical features of mediastinitis differ according to the underlying cause of the disease. Since the morbidity and mortality rates of mediastinitis are high, appropriate antibacterial prophylaxis and prompt initiation of empirical antibacterial therapy together with surgical debridment in case of clinical suspicion of mediastinitis is of paramount importance. Klimik Dergisi 2012; 25(1): 2-5.

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“…However, it must be considered that the same absolute values of PCT cannot be used in all circumstances. It has been reported that PCT levels are higher in surgical compared to medical patients [12], and elevated PCT can also be present without infection, in conditions such as trauma [13] and surgery [14] or after cardiac arrest [15]. There is some evidence that evaluating PCT kinetics may be superior to absolute values [12, 16].…”

Section: Introductionmentioning

confidence: 99%

Delta Procalcitonin Is a Better Indicator of Infection Than Absolute Procalcitonin Values in Critically Ill Patients: A Prospective Observational Study

Trásy

Tánczos

Németh

et al. 2016

Journal of Immunology Research

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Purpose. To investigate whether absolute value of procalcitonin (PCT) or the change (delta-PCT) is better indicator of infection in intensive care patients. Materials and Methods. Post hoc analysis of a prospective observational study. Patients with suspected new-onset infection were included in whom PCT, C-reactive protein (CRP), temperature, and leukocyte (WBC) values were measured on inclusion (t 0) and data were also available from the previous day (t −1). Based on clinical and microbiological data, patients were grouped post hoc into infection- (I-) and noninfection- (NI-) groups. Results. Of the 114 patients, 85 (75%) had proven infection. PCT levels were similar at t −1: I-group (median [interquartile range]): 1.04 [0.40–3.57] versus NI-group: 0.53 [0.16–1.68], p = 0.444. By t 0 PCT levels were significantly higher in the I-group: 4.62 [1.91–12.62] versus 1.12 [0.30–1.66], p = 0.018. The area under the curve to predict infection for absolute values of PCT was 0.64 [95% CI = 0.52–0.76], p = 0.022; for percentage change: 0.77 [0.66–0.87], p < 0.001; and for delta-PCT: 0.85 [0.78–0.92], p < 0.001. The optimal cut-off value for delta-PCT to indicate infection was 0.76 ng/mL (sensitivity 80 [70–88]%, specificity 86 [68-96]%). Neither absolute values nor changes in CRP, temperature, or WBC could predict infection. Conclusions. Our results suggest that delta-PCT values are superior to absolute values in indicating infection in intensive care patients. This trial is registered with ClinicalTrials.gov identifier: NCT02311816.

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Diagnostic value and prognostic implications of serum procalcitonin after cardiac surgery: a systematic review of the literature

Cited by 150 publications

References 69 publications

Procalcitonin kinetics after burn injury and burn surgery in septic and non-septic patients – a retrospective observational study

Procalcitonin kinetics after burn injury and burn surgery in septic and non-septic patients – a retrospective observational study

Mediastinitis

Delta Procalcitonin Is a Better Indicator of Infection Than Absolute Procalcitonin Values in Critically Ill Patients: A Prospective Observational Study

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