Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after major surgery

Mokart, Djamel; Merlin, Mark A.; Sannini, Antoine; Brun, Jean-Paul; Delpero, Jean‐Robert; Houvenaeghel, G.; Moutardier, Vincent; Blache, J.L.

doi:10.1093/bja/aei143

Cited by 219 publications

(166 citation statements)

References 25 publications

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“…In previous studies, a simple plasma measurement served as the basis to define the status of the immune response during ongoing sepsis (25) and patients are considered hyperinflammatory if proinflammatory cytokines are found at elevated levels. We now report that the early phase of lethal sepsis is characterized by the overexpression of both proinflammatory as well as anti-inflammatory cytokines.…”

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confidence: 99%

Circulating Cytokine/Inhibitor Profiles Reshape the Understanding of the SIRS/CARS Continuum in Sepsis and Predict Mortality

Osuchowski

Welch

Siddiqui

et al. 2006

The Journal of Immunology

470

379

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Mortality in sepsis remains unacceptably high and attempts to modulate the inflammatory response failed to improve survival. Previous reports postulated that the sepsis-triggered immunological cascade is multimodal: initial systemic inflammatory response syndrome (SIRS; excessive pro-, but no/low anti-inflammatory plasma mediators), intermediate homeostasis with a mixed anti-inflammatory response syndrome (MARS; both pro- and anti-inflammatory mediators) and final compensatory anti-inflammatory response syndrome (CARS; excessive anti-, but no/low proinflammatory mediators). To verify this, we examined the evolution of the inflammatory response during the early phase of murine sepsis by repetitive blood sampling of septic animals. Increased plasma concentrations of proinflammatory (IL-6, TNF, IL-1β, KC, MIP-2, MCP-1, and eotaxin) and anti-inflammatory (TNF soluble receptors, IL-10, IL-1 receptor antagonist) cytokines were observed in early deaths (days 1–5). These elevations occurred simultaneously for both the pro- and anti-inflammatory mediators. Plasma levels of IL-6 (26 ng/ml), TNF-α (12 ng/ml), KC (33 ng/ml), MIP-2 (14 ng/ml), IL-1 receptor antagonist (65 ng/ml), TNF soluble receptor I (3 ng/ml), and TNF soluble receptor II (14 ng/ml) accurately predicted mortality within 24 h. In contrast, these parameters were not elevated in either the late-deaths (day 6–28) or survivors. Surprisingly, either pro- or anti-inflammatory cytokines were also reliable in predicting mortality up to 48 h before outcome. These data demonstrate that the initial inflammatory response directly correlates to early but not late sepsis mortality. This multifaceted response questions the use of a simple proinflammatory cytokine measurement for classifying the inflammatory status during sepsis.

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mentioning

confidence: 99%

Circulating Cytokine/Inhibitor Profiles Reshape the Understanding of the SIRS/CARS Continuum in Sepsis and Predict Mortality

Osuchowski

Welch

Siddiqui

et al. 2006

The Journal of Immunology

470

379

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“…When the body is subjected to surgical stress, levels of inflammatory cytokines such as TNF-␣, IL-1␤, IL-6 and IL-8 are known to increase, while at the same time, levels of anti-inflammatory cytokines such as IL-4 and IL-10 are also elevated. From the perspective of measurement sensitivity, IL-6 in the plasma can be easily detected after surgery, and is frequently used as a SIRS marker 3,7,11,[15][16][17][21][22][23]27,31) . Studies have shown that plasma levels of IL-6 are significantly higher in patients with postoperative SIRS 7,20,22,31) , remain high in deceased patients with SIRS 7,20) , and closely reflect degree of surgical stress 4) .…”

Section: Changes In Cytokinesmentioning

confidence: 99%

Systemic Inflammatory Response Syndrome and postoperative complications after orthognathic surgery

Kasahara

Yamamura²,

Sugahara³

et al. 2014

Journal of Oral and Maxillofacial Surgery

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Symptoms of Systemic Inflammatory Response Syndrome (SIRS) presenting immediately after surgery have lately been regarded as potential warnings of impending postoperative complications and multiple organ failure. Reports discussing the relationship between operative stress and SIRS are found in the field of digestive surgery, but not in that of oral surgery. Sixty-five patients with jaw deformity who had undergone maxillary and mandibular orthognathic surgery (Le Fort I osteotomy and sagittal splitting ramus osteotomy) between September 2003 and October 2006 were involved in this study. A search based on the SIRS diagnostic criteria resulted in assignment of 33 cases to the SIRS group and 32 cases to the non-SIRS group. Postoperative complications occurred in 27.3% of the SIRS group and 0.0% of the non-SIRS group (pϽ0.01). In four cases, a postoperative fluctuation in IL-6 level evaluated. These results suggest the importance of careful management of postoperative SIRS patients in preventing complications.

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“…The signs of systemic inflammatory response syndrome (SIRS) were identified if the patient had a body temperature <35.6°C or >38.3°C, tachycardia >90 beats per min (bpm), ventilatory frequency >20 bpm or Pa CO2 <4.27 kPa (unless the patient was mechanically ventilated), a white cell count ≥12×10 9 /l or ≤4×10 9 /l, or >10 % immature neutrophils (bands), as previously described [10]. Sepsis was defined when the patients had SIRS associated with infection according to Bones' criteria [11].…”

Section: Experimental Assignmentmentioning

confidence: 99%

“…Infection was identified if microbiological cultures obtained from the patients at possible sites of infection were positive (proven infection) or if clinical signs of infection were evident. Patients were assigned into two groups: the sepsis group (patients with sepsis, severe sepsis [10], and septic shock [10]) and the control group (patients with SIRS or no evidence of sepsis).…”

Section: Experimental Assignmentmentioning

confidence: 99%

Value of Serum Procalcitonin in Evaluating the Prognosis of Sepsis in Elderly Patients with Colorectal Cancer Undergoing Emergency Colorectal Surgery

Zou

Cai

et al. 2012

Indian J Surg

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Serum procalcitonin (PCT) levels may have predictive value in the prognosis of postoperative sepsis in elderly patients who have undergone colorectal surgery for colorectal cancer in intensive care units (ICUs). A prospective study involving 90 critically ill patients who underwent colorectal surgery for colorectal cancer in ICUs was performed. Twenty-eight patients were diagnosed with sepsis, in accordance with the American College of Chest Physicians/Society of Critical Care Medicine consensus criteria, and these patients were included in the sepsis group. Sixtytwo patients, who were without evidence of sepsis, were enrolled in the control group. We measured the serum PCT concentrations preoperatively (immediately before induction of anesthesia), upon arrival in the ICU (ICU day 0), on the morning of the first postoperative day (postoperative day 1), and on the morning of the third postoperative day (postoperative day 3). The C-reactive protein (CRP) index, acute physiology and chronic health evaluation II (APACHE II) score, mechanical duration of ventilation, mortality rate, incidence of multiple organ failure, and usage of continuous renal replacement therapy were evaluated. The area under the curve for the receiver operating characteristic curve (AUC-ROCC) was measured to explore the association between the serum PCT and the prognosis. In the sepsis group, 12/28 patients died (mortality rate 43 %). In the control group, 6/ 62 patients died (mortality rate 9.7 %). On the first postoperative day, the serum PCT level was dramatically higher in the sepsis group than in the control group (2.71±1.13 vs. 1.37± 0.57, P≤0.05). The PCT level on the first postoperative day was distinctly higher than that measured upon arrival in the ICU (2.71±1.13 vs. 1.31±0.58, P≤0.05). In the two groups, the CRP concentrations were both markedly higher on the first postoperative day than upon arrival in the ICU (138.89±45.12 vs. 70.43±23.54 in the sepsis group, and 133.13±44.91 vs. 69.65±24.98 in the control group, P≤0.05). Linear regression analysis was performed. The results suggest that the PCT and APACHE-II scores were not significantly associated. On the first and third postoperative days, the PCT levels were associated with increased odds of sepsis (AUC-ROCC, 95 % confidence interval 0.817-0.973, P 00.000, and 0.755-0.944, P00.000, respectively). The outcomes of patients in the sepsis group were worse than those in the control group. PCT levels appear to be early markers of postoperative sepsis in elderly patients undergoing colorectal surgery for colorectal cancer during the ICU course. These findings could allow for early identification of postoperative septic complications and be used for prognostic evaluation of these patients.

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Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after major surgery

Abstract: PCT and IL-6 appear to be early markers of subsequent postoperative sepsis in patients undergoing major surgery for cancer. These findings could allow identification of postoperative septic complications.

Cited by 219 publications

References 25 publications

Circulating Cytokine/Inhibitor Profiles Reshape the Understanding of the SIRS/CARS Continuum in Sepsis and Predict Mortality

Circulating Cytokine/Inhibitor Profiles Reshape the Understanding of the SIRS/CARS Continuum in Sepsis and Predict Mortality

Systemic Inflammatory Response Syndrome and postoperative complications after orthognathic surgery

Value of Serum Procalcitonin in Evaluating the Prognosis of Sepsis in Elderly Patients with Colorectal Cancer Undergoing Emergency Colorectal Surgery

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