The Value of Serum Procalcitonin Level for Differentiation of Infectious from Noninfectious Causes of Fever After Orthopaedic Surgery

Hunziker, Sabina; Hügle, Thomas; Schuchardt, Katrin; Groeschl, I; Schuetz, Philipp; Müeller, Beat; Dick, W.; Eriksson, Urs; Trampuž, Andrej

doi:10.2106/jbjs.h.01600

Cited by 75 publications

(58 citation statements)

References 37 publications

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“…Moreover, serum PCT level was proclaimed as a significant predictor for postoperative infection. 17,18 Diagnostic test showed that the sensitivity and specificity of serum PCT level in detecting SSI was higher than those of leucocyte count in this study. This result is in line with previous studies reported by some authors.…”

contrasting

confidence: 51%

“…Serum PCT level showed a better predictor than leucocyte count to detect an infection caused by S. negative-coagulase growth. 22 Although many studies reported that serum PCT level had a high predictive value in detecting infection after surgery, [18][19][20][21][22] however, a study conducted in patients who underwent elective spinal urgery gave different result, as serum PCT level in general remained at <0.25 ng/mL during the postoperative course. Moreover, serum PCT level did not correlate with age, sex, DM, hypertension, BMI, operation time, operation site, or use of instrumentation.…”

mentioning

confidence: 99%

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Sensitivity and specificity of serum procalcitonin level compared to leucocyte count for diagnosis of surgical site infection on patients undergoing major surgery

2013

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Surgical site infection (SSI) is one of the most serious complications on sugical procedure. However, its diagnosis is still based on the clinical and laboratory examination that take more time and less sensitive and specific. Therefore, early diagnosis that is more accurate and precise is needed. Some biomarker such as serum procalcitonin (PCT) is promoted for diagnosis SSI. The aim of the study was to evaluate the sensitivity and specificity of serum PCT compared with leucocyte for diagnosis of SSI on patients undergoing major surgery. This was a descriptive analytical study with a prospective observational design. Patients who underwent a major surgery between October 30 th and December 31 st , 2011 and fulfilled the inclusion and exclusion criteria were recruited. Clinical and laboratory examinations including leucocyte count were conducted presurgery. On 3 rd day postsurgery, blood sample was taken for PCT and leucocyte count measurement. A blood bacterial culture was performed on patients suffering from SSI according to Centers for Disease Control (CDC) criteria. Patients were then followed until 30 days postsurgery. A total of 49 patients consisting of 22 men and 27 women were involved in this study. Surgical site infection was found in 16 patients consisting of 8 (50%) patients with clean surgical wound, 3 (19%) patients with clean surgical contamination wound, 4 (25%) patients with surgical contamination wound and 1 (6%) patient with dirty surgical wound. Furthermore, laboratory examination found that 9 patients had abnormal leucocyte with 6 of them suffering from SSI, whereas from 15 patients with serum PCT abnormal, and 11 patients suffered from SSI. Diagnostic test showed that the sensitivity and specificity of serum PCT for diagnosis of SSI were 68.75 and 90.90%, respectively, whereas the sensitivity and specificity of leucocyte were 31.25 and 87.87%, respectively. In conclusion, serum PCT has better sensitivity and specificity compared with leucocyte for the diagnosis of SSI in patients with major surgery. ABSTRAKInfeksi luka operasi (ILO) merupakan salah satu komplikasi paling serius pada pembedahan. Namun demikian, diagnosis ILO masih bedasarkan pemeriksaan klinik dan laboratorium yang butuh waktu lama dan kurang sensitif maupun spesifik. Oleh karena itu, diagnosis dini yang lebih akurat dan tepat diperlukan. Beberapa biomarker seperti kadar prokalsitonin (PCT) dipromosikan untuk diagnosis SSI. Penelitian ini bertujuan untuk mengkaji sensitivitas dan spesifisitas PCT serum dibandingkan leukosit untuk diagnosis ILO pada pasien yang menjalani bedah mayor. Penelitian ini merupakan penelitian deskriptif analitik dengan rancangan observasional prospektif. Pasien yang menjalani bedah mayor antara 30 Oktober dan 31 Desember 2011 dan memenuhi kriteria inklusi dan eksklusi dilibatkan dalam penelitian. Hari ke 3 setelah 19%) pasien dengan luka operasi bersih kontaminasi, 4 (25%) pasien dengan luka operasi kontaminasi dan 1 (6%) pasien dengan luka operasi kotor. Pada pemeriksaan laboratorium dite...

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contrasting

confidence: 51%

mentioning

confidence: 99%

Sensitivity and specificity of serum procalcitonin level compared to leucocyte count for diagnosis of surgical site infection on patients undergoing major surgery

2013

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“…Others have found sensitivity and specificity values for procalcitonin in similar ranges (Table 3) [2,5,11,14,21,26,29,30,33]. However, the results reported by Worthington et al were quite different: serum procalcitonin did not help distinguish between infectious and noninfectious causes of prosthetic hip loosening [41].…”

Section: Discussionmentioning

confidence: 91%

“…Numerous studies have shown procalcitonin is elevated in cases of bacterial infection or sepsis and levels are considerably higher in bacterial infections than in viral infections [2,5,11,14,21,26,29,30,33]. Procalcitonin increases 2 to 4 hours after the onset of sepsis, which is later than proinflammatory cytokines, such as interleukin 6 (IL-6), but considerably earlier than CRP [31].…”

Section: Introductionmentioning

confidence: 99%

Novel Biomarkers to Detect Infection in Revision Hip and Knee Arthroplasties

Glehr

Friesenbichler

Hofmann

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background A periprosthetic joint infection is one of the most challenging complications associated with THA and TKA. In the diagnostic process for detecting a periprosthetic joint infection, one of the most important steps is analysis of laboratory infection biomarkers. Questions/purposes We investigated the sensitivity and specificity of the biomarkers procalcitonin, interleukin 6 (IL-6), and interferon a (IFN-a) as compared with conventional biomarkers (C-reactive protein [CRP], leukocyte level) for a periprosthetic joint infection associated with revision arthroplasties. Methods We prospectively included and analyzed 84 patients (124 revision arthroplasties). The blood parameters of interest were procalcitonin, IL-6, IFN-a, leukocyte level, and CRP. Samples were taken preoperatively and on the first, third, and seventh postoperative days. The sensitivity and specificity of these biomarkers then were calculated. Results Considering the preoperative values of 84 patients (124 operations), procalcitonin, IL-6, CRP, and leukocyte level correlated with periprosthetic joint infection, whereas IFN-a did not. A procalcitonin cut-off level of 0.35 ng/mL revealed a sensitivity of 80% and specificity of 37%. An IL-6 cut-off level of 2.55 pg/mL had a sensitivity of 92% and specificity of 59%. Conclusions In this study procalcitonin and IL-6 were helpful for detecting periprosthetic joint infections in revision arthroplasties, although CRP generally was superior. Procalcitonin and IL-6 may be considered adjuvant tests when the diagnosis of a periprosthetic joint infection is in doubt. This study showed, in addition to conventional biomarkers such as CRP and leukocyte level, procalcitonin and IL-6 were helpful for detecting infections associated with revision arthroplasties.

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“…5 Measurement of PCT in particular has gained interest because it is a quantitative test that exhibits predictable value and is more responsive to postoperative events compared with CRP and ESR. [6][7][8] Nevertheless, in current clinical practice, PCT are not widely used as routine screening tests in the early postoperative period, with most surgeons relying on the leukocyte count, CRP and ESR despite evidence that these are poor diagnostic tests. 9 PCT was already used in several other studies to predict postoperative infections after several different operations, [5][6][7][8]10,11 however, the predictive value of serum PCT in detecting postoperative infectious complications in spinal cord injury patients has not been studied.…”

Section: Introductionmentioning

confidence: 99%

Procalcitonin as an early predictor of postoperative infectious complications in patients with acute traumatic spinal cord injury

Nie

Jiang

et al. 2011

Spinal Cord

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Study design: Prospective, nonrandomized, observational cohort study. Objectives: To analyze procalcitonin (PCT) level in acute traumatic spinal cord injury patients with and without postoperative infectious complications, and to determine whether PCT is a prognostic parameter of infectious complications in the early postoperative period compared with other inflammatory markers. Setting: Spine center of Chongqing, China; Trauma center of Chinese People's Liberation Army, China. Methods: A total of 339 consecutive patients with acute spinal cord injury undergone surgery were evaluated. All patients underwent measurement of leukocyte count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum PCT preoperatively and 24-48 h postoperatively. Results: In all, 26 (7.7%) of 339 participants experienced postoperative infectious complication. Patients with infection exhibited significantly higher PCT and CRP levels compared with noninfection (both Po0.01). Multivariate logistic regression analysis showed that PCT and CRP levels were independent predicators for postoperative infection. The area under the receiver operating characteristics curve of PCT and CRP were 0.82 (95% confidence intervals (CI) 0.74-0.91) and 0.68 (95%CI, 0.57-0.78), respectively. A PCT cutoff of 0.1 ng ml À1 had a reasonable sensitivity of 92% to exclude an infection and antibiotics can be initially withheld. However, in patients with PCT level above 0.5 ng ml À1 , a rapid initiation of antibiotics may be warranted. Conclusions: Serum PCT is a more reliable biologic marker for the early prediction of postoperative infectious complications in patients with acute traumatic spinal cord injury compared with CRP. PCT can early identify postoperative infections for establishing effective antibiotic therapy.

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The Value of Serum Procalcitonin Level for Differentiation of Infectious from Noninfectious Causes of Fever After Orthopaedic Surgery

Abstract: Serum procalcitonin is a helpful diagnostic marker supporting clinical and microbiological findings for more reliable differentiation of infectious from noninfectious causes of fever after orthopaedic surgery.

Cited by 75 publications

References 37 publications

Sensitivity and specificity of serum procalcitonin level compared to leucocyte count for diagnosis of surgical site infection on patients undergoing major surgery

Sensitivity and specificity of serum procalcitonin level compared to leucocyte count for diagnosis of surgical site infection on patients undergoing major surgery

Novel Biomarkers to Detect Infection in Revision Hip and Knee Arthroplasties

Procalcitonin as an early predictor of postoperative infectious complications in patients with acute traumatic spinal cord injury

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