The role of procalcitonin in the diagnosis of bacterial infection after major abdominal surgery: Advantage from daily measurement

Abstract

Postsurgical infections represent an important cause of morbidity after abdominal surgery. The microbiological diagnosis is not achieved in at least 30% of culture with consequent worsening of patient outcome. In this study, procalcitonin measurement, during the first 3 days after abdominal surgery, has been evaluated for the early diagnosis of postsurgical infection.Ninety consecutive patients subjected to major abdominal surgery at the University Campus Bio-Medico of Rome, have been included. PCT concentrations were measured by time-resolved amplified cryptate emission (TRACE) assay at admission and at the first, second, and third day after surgery. PCT levels were compared using the Mann-Whitney test and by ANOVA test for variance analysis. Receiver operating characteristic (ROC) analysis was performed to define the diagnostic ability of PCT in case of postsurgical infections.PCT values resulted significantly different between patients developing or not developing postsurgical infections. PCT >1.0 ng/mL at first or second day after surgery and >0.5 ng/mL at third day resulted diagnostic for infectious complication, whereas a value <0.5 ng/mL at the fifth day after surgery was useful for early and safety discharge of patients.In conclusion, PCT daily measurement could represent a useful diagnostic tool improving health care in the postsurgical period following major abdominal surgery and should be recommended.

Figure 1

Mann–Whitney test. PCT comparison between complicated and not complicated (n) patients at different time points: preoperative (pre-O); first, second, and third day after surgery (I day, II day, and III day).

Figure 2

ROC curve analysis: PCT ability to differentiate infected and not infected patients at different time points preoperative day (T0), first, second, and third postoperative days (T1, T2, and T3). Area under the ROC curve (AUC) values and 95% confidence interval (CI).

Figure 3

ROC curve comparison: PCT ability to differentiate infected and not infected patients at different time points preoperative day (T0), first, second, and third postoperative days (T1, T2, and T3).

Figure 4

ANOVA analysis of variance on PCT measurement at different time points in the 2 groups of patients with and without infection (1,0).