Procalcitonin as a predictive marker for surgical site infection in elective colorectal cancer surgery

• Published in: Langenbeck's archives of surgery Vol. 398; no. 6; pp. 833 - 839
• Main Authors: Takakura, Yuji, Hinoi, Takao, Egi, Hiroyuki, Shimomura, Manabu, Adachi, Tomohiro, Saito, Yasufumi, Tanimine, Naoki, Miguchi, Masashi, Ohdan, Hideki
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2013
• Subjects: Abdominal Surgery; Adult; Aged; Aged, 80 and over; Area Under Curve; Biomarkers - blood; C-Reactive Protein - analysis; C-Reactive Protein - metabolism; Calcitonin - analysis; Calcitonin - blood; Calcitonin Gene-Related Peptide; Cardiac Surgery; Cohort Studies; Colectomy - adverse effects; Colectomy - methods; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Early Diagnosis; Elective Surgical Procedures - adverse effects; Elective Surgical Procedures - methods; Female; Fever - diagnosis; General Surgery; Humans; Inflammation Mediators - blood; Leukocyte Count; Male; Medicine; Medicine & Public Health; Middle Aged; Odds Ratio; Original Article; Predictive Value of Tests; Prognosis; Protein Precursors - analysis; Protein Precursors - blood; Risk Assessment; ROC Curve; Surgical Wound Infection - blood; Surgical Wound Infection - diagnosis; Thoracic Surgery; Traumatic Surgery; Treatment Outcome; Vascular Surgery; Surgical site infection; Colorectal surgery; Procalcitonin; Colorectal cancer
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-013-1095-0

Purpose Surgical site infection (SSI) is a frequent complication of elective surgery for colorectal cancer. The classical clinical markers of infection—elevations in white blood cell count, C-reactive protein (CRP) level, and body temperature—do not precisely predict SSI after elective colorectal resection. The objective of this study was to evaluate the efficacy of procalcitonin (PCT) as a tool for diagnosis of SSI in elective surgery for colorectal cancer. Methods A total of 114 consecutive patients undergoing elective colorectal resection for cancer were evaluated. Routine blood samples, for determining PCT level, CRP plasma concentration, and white blood cell count, were obtained on postoperative days (POD) 1 and 3. Predictive values for each of the laboratory markers were examined. Results SSI was diagnosed in 18 (15.7 %) of 114 patients. Patients with SSI exhibited significantly higher PCT levels (on PODs 1 and 3) and CRP levels (on POD 3) than did patients without SSI. According to receiver operating characteristic analysis, PCT showed the highest area under the curve (AUC) for predicting SSI on both PODs 1 and 3 (AUC, 0.76 and 0.77, respectively). Multivariate logistic regression analysis showed that PCT (on PODs 1 and 3) was an independent predictor for SSI (odds ratio = 14.41 and 9.79, respectively). Conclusion Serum PCT is more reliable laboratory marker for the early diagnosis of SSI after elective colorectal cancer surgery, compared with conventional inflammatory indicators. PCT could serve as an additional diagnostic tool for the early identification of SSI to improve clinical decision making.