Can procalcitonin help us in timing of re-intervention in septic patients after multiple trauma or major surgery?

Abstract

Background/aims: In surgical sepsis, the rapid identification of source of infection at an early stage after surgery or serious trauma is crucial for favorable outcome. The discrimination between local and generalized infection is critical for correct treatment.

Methodology: In a randomized, controlled, single-centre study we investigated 72 patients with severe sepsis after major abdominal surgery or surgery for multiple trauma. Patients were divided in 2 groups: in the first group (PCT, n=38), more important role in the treatment decision was given to PCT level (severe sepsis with PCT >2 ng/mL signalled bacteremia and pushed us to change antibiotics and intravascular devices, severe sepsis with PCT < or =2 ng/mL prompted use of ultrasonography and/or CT, followed by repeated surgery in patients with localized infection). The control group (CON, n=34) was treated by standard evaluation of all parameters by consultant surgeon. We investigated 28-day all-cause mortality, sepsis-related complications, the duration of stay in the intensive care unit, and ventilated days.

Results: The hospital mortality was in PCT group 26% and 38% in control group (p = 0.28). Average SOFA score was 7.9 +/- 2.8 in PCT group vs. 9.3 +/- 3.3 (p = 0.06). The decline of ICU days (16.1 +/- 6.9 vs. 19.4 +/- 8.9; p = 0.09) and ventilated days (10.3 +/- 7.8 vs. 13.9 +/- 9.4; p = 0.08) in PCT group was observed, but the difference was not significant.

Conclusions: We observed a clear tendency to decrease extent of multiple organ dysfunction syndrome in patients, in which therapeutic decision was made earlier using procalcitonin as an additional marker separating local infection from generalized one.