Open AccessProcalcitonin plasma level as a marker of systemic infection in surgical patients in the intensive care unit
Author(s) -
Giannopoulou P.,
Greka P.,
Voros D.,
Giamarellou H.
Publication year - 2000
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1046/j.1365-2168.2000.01544-38.x
Subject(s) - procalcitonin , medicine , sepsis , systemic inflammatory response syndrome , acute pancreatitis , white blood cell , intensive care unit , gastroenterology , septic shock , peritonitis , pancreatitis , etiology , systemic inflammation , surgery , inflammation
Background Increased (more than 0·5 ng ml −1 ) extrathyroidal production of procalcitonin (PCT; the prodromal molecule of calcitonin) has been proven to characterize cases of systemic bacterial infection. The aim of the present study was to investigate the possible role of PCT as an infection marker in 59 febrile surgical patients in the intensive care unit who were under several antimicrobial regimens. Methods PCT values were calculated every other day during the whole duration of the febrile period using the immunochemiluminescence method (Brahms Diagnostica, Berlin, Germany). A subgroup of ten patients (three with multiple trauma, seven with an intra‐abdominal site of infection) were considered to have sepsis (SS) because of their positive blood cultures (two Gram positive, eight Gram negative). A total of 30 patients presented with the systemic inflammatory response syndrome (SIRS), which was considered to have a septic aetiology in nine (four with peritonitis, one with pancreatitis and four with multiple trauma) (white blood cell count greater than 25 000 μl −1 , temperature above 39·5°C). Of the remaining patients, seven had an intra‐abdominal abscess (IA) with various causes, six had acute non‐complicated pancreatitis (AP) and six had localized burns (LB) (13·5–25 per cent of the total body surface). Results PCT values on the first day of fever (asymmetrical underlying distribution) are shown in the Table.SS SIRS AP LB All patients Septic origin IAPCT (ng ml −1 ) 8·1 (2·8–81·7) 2·5 (0·1–55) 5·0 (0·6–55) 1·4 (0–7·3) 0·4 (0·1–1·3) 0·3 (0·1–0·9)Values are median (range)Conclusion (1) Increased PCT levels are the hallmark of sepsis even from the first day of its appearance as opposed to cases of localized infection. (2) PCT levels are increased in cases of SIRS of infectious origin. (3) Low PCT levels (less than 1 ng ml −1 ) in patients with pancreatitis are indicative of an uncomplicated evolution. (4) Unexpectedly high PCT levels should be taken into consideration for the choice of optimal antimicrobial regimen. © 2000 British Journal of Surgery Society Ltd