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

Abstract

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.

Procalcitonin Increase Is Associated with the Development of Critical Care-Acquired Infections in COVID-19 ARDS

“…As such, our study employed a predetermined rise in PCT, utilising trends in serial PCT levels rather than a critical tipping point as an indicator for secondary infection, which could be adopted in clinical practice. PCT kinetics have been successfully used to detect nosocomial infections and to monitor the appropriateness of antimicrobial therapy [ 25 , 26 , 27 , 28 , 29 , 30 ]. Our definition of PCT rise was based on these previous trials, to provide an easily accessible clinical tool at the bedside.…”

“…There is no universally accepted value to define the dynamic changes of these biomarkers and, in this context, any such definition has drawbacks. We tried to mitigate this by using delta values from previously published studies [ 25 , 26 , 27 , 28 , 29 , 30 ]. In our statistical model, we did not specifically control for the timing of the biomarker rise and the development of VAP/VAT or LCBI.…”

Contemporary Aspects of Burn Care

“…The more expensive Procalcitonin is more specific to infection and has a shorter half-life and may therefore be useful as a marker of change in condition. Although it has been shown to be a relatively good marker for sepsis and survival in burn patients, its levels are subject to fluctuations in response to surgery and different types of microbial agents, making interpretations more complicated [77,[86][87][88][89][90].…”

Incidence and Time Point of Sepsis Detection as Related to Different Sepsis Definitions in Severely Burned Patients and Their Accompanying Time Course of Pro-Inflammatory Biomarkers

“…Only Sepsis-1 includes the white blood cell count (WBC), while Sepsis ABA 2007 and Sepsis-3 include the thrombocyte count as a “pro-inflammatory correlate”. Additionally, these canonical biomarkers often fail to uncover infectious events at an incipient stage of the disease as their alterations are prone to interfere with further stimuli such as trauma severity (i.e., total burned surface area (TBSA) in burns), repetitive surgical interventions, and concomitant conditions like inhalation injury [ 12 , 13 , 14 ]. Recently, evidence on the usefulness of pancreatic stone protein (PSP) as an accurate diagnostic and prognostic marker in critically ill patients is accumulating [ 15 , 16 , 17 ].…”