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

Abstract

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.

Inflammatory responses and histopathological changes in a mouse model of Staphylococcus aureus-induced bloodstream infections

“…IL-6 is the major stimulant in CRP synthesis during acute-phase responses [26]. The maximum IL-6 plasma levels precede the maximal concentrations of PCT, suggesting that the synthesis of PCT might be induced by IL-6.…”

Utility of blood procalcitonin concentration in the management of cancer patients with infections

“…Because PCT concentrations can be periodically elevated after operation, its measurement postoperatively can improve patient management and can be helpful in prediction of serious infections, only when the range of PCT concentrations are followed up. 26 , 27 Picariello et al 28 reported that PCT concentrations measured at the time of admission to the cardiac critical care unit have been elevated in patients with cardiogenic shock in the presence of multiple organ failure and in the absence of signs of infections (PCT levels ≥1.0 ng/mL). In survivors, a progressive reduction in PCT values was observed, whereas the lack of changes in PCT concentrations was documented in those who died.…”

Clinico-pathological features of colon cancer patients undergoing emergency surgery: a comparison between elderly and non-elderly patients

“…In the literature the cut-off for a definition of elderly varies from being either 65 or 75 years of age. Many studies define as “elderly” only patients older than 80 years [10, 11, 12, 13, 14, 15]. At present, the WHO still consider as elderly those individuals of 60 years or over; however most scientific societies define patients as elderly if their age is 65 year or more.…”