Serum procalcitonin as a predictor of infectious complications after pancreaticoduodenectomy: review of the literature and our experience

  • Hiroya IidaEmail author
  • Hiromitsu Maehira
  • Haruki Mori
  • Masaji Tani
Review Article


Procalcitonin (PCT) is an early predictor of bacterial infection. We reviewed the literature and analyzed data on our own patients to assess the value of PCT as a predictor of infectious complications after pancreaticoduodenectomy (PD). The relevant literature published up until November 30, 2018, was reviewed, with no publication date restrictions. Letters to the editor and studies lacking necessary data were excluded. We also reviewed, retrospectively, the medical records of 77 patients who underwent PD between January, 2011 and April, 2016 at our hospital, to evaluate infectious complications and laboratory results on postoperative days (PODs) 1 and 3. Six studies were screened, and four cohort studies on patients undergoing PD were analyzed. One report examined preoperative PCT and C-reactive protein (CRP) levels, whereas the others examined only postoperative PCT and/or CRP levels. All reports demonstrated the usefulness of PCT as a predictor of postoperative infectious complications; however, no report concluded that PCT was a better predictor than CRP, except for the one report that examined preoperative PCT levels. Conversely, our experience demonstrated that the most significant factor predicting infectious complications was PCT on POD 3 (sensitivity, 0.87; specificity, 0.88). Thus, serum PCT could be a predictor of all complications, including infectious complications, after PD, but no advantage over CRP was identified.


Infectious complications Pancreaticoduodenectomy Procalcitonin 



None declared.

Compliance with ethical standards

Conflict of interest

The authors declares that they have no conflict of interest.


  1. 1.
    Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg. 1997;226(3):248–57 (discussion 57–60).CrossRefGoogle Scholar
  2. 2.
    Buchler MW, Wagner M, Schmied BM, Uhl W, Friess H, Z’Graggen K. Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy. Arch Surg. 2003;138(12):1310–4 (discussion 5).CrossRefGoogle Scholar
  3. 3.
    Schmidt CM, Powell ES, Yiannoutsos CT, Howard TJ, Wiebke EA, Wiesenauer CA, et al. Pancreaticoduodenectomy: a 20-year experience in 516 patients. Arch Surg. 2004;139(7):718–25 (discussion 25–7).CrossRefGoogle Scholar
  4. 4.
    DeOliveira ML, Winter JM, Schafer M, Cunningham SC, Cameron JL, Yeo CJ, et al. Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg. 2006;244(6):931–7 (discussion 7–9).CrossRefGoogle Scholar
  5. 5.
    Kimura W, Miyata H, Gotoh M, Hirai I, Kenjo A, Kitagawa Y, et al. A pancreaticoduodenectomy risk model derived from 8575 cases from a national single-race population (Japanese) using a web-based data entry system: the 30-day and in-hospital mortality rates for pancreaticoduodenectomy. Ann Surg. 2014;259(4):773–80.CrossRefGoogle Scholar
  6. 6.
    Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589–96.CrossRefGoogle Scholar
  7. 7.
    Luster W, Gropp C, Sostmann H, Kalbfleisch H, Havemann K. Demonstration of immunoreactive calcitonin in sera and tissues of lung cancer patients. Eur J Cancer Clin Oncol. 1982;18(12):1275–83.CrossRefGoogle Scholar
  8. 8.
    Gropp C, Luster W, Havemann K. Salmon and human calcitonin like material in lung cancer. Br J Cancer. 1985;51(6):897–901.CrossRefGoogle Scholar
  9. 9.
    Zajac JD, Martin TJ, Hudson P, Niall H, Jacobs JW. Biosynthesis of calcitonin by human lung cancer cells. Endocrinology. 1985;116(2):749–55.CrossRefGoogle Scholar
  10. 10.
    Cate CC, Pettengill OS, Sorenson GD. Biosynthesis of procalcitonin in small cell carcinoma of the lung. Cancer Res. 1986;46(2):812–8.Google Scholar
  11. 11.
    Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993;341(8844):515–8.CrossRefGoogle Scholar
  12. 12.
    Schwarz S, Bertram M, Schwab S, Andrassy K, Hacke W. Serum procalcitonin levels in bacterial and abacterial meningitis. Crit Care Med. 2000;28(6):1828–32.CrossRefGoogle Scholar
  13. 13.
    Linscheid P, Seboek D, Nylen ES, Langer I, Schlatter M, Becker KL, et al. In vitro and in vivo calcitonin I gene expression in parenchymal cells: a novel product of human adipose tissue. Endocrinology. 2003;144(12):5578–84.CrossRefGoogle Scholar
  14. 14.
    Muller B, Peri G, Doni A, Perruchoud AP, Landmann R, Pasqualini F, et al. High circulating levels of the IL-1 type II decoy receptor in critically ill patients with sepsis: association of high decoy receptor levels with glucocorticoid administration. J Leukoc Biol. 2002;72(4):643–9.Google Scholar
  15. 15.
    Meisner M, Tschaikowsky K, Palmaers T, Schmidt J. Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS. Crit Care. 1999;3(1):45–50.CrossRefGoogle Scholar
  16. 16.
    Nylen ES, O’Neill W, Jordan MH, Snider RH, Moore CF, Lewis M, et al. Serum procalcitonin as an index of inhalation injury in burns. Horm Metab Res. 1992;24(9):439–43.CrossRefGoogle Scholar
  17. 17.
    Tang BM, Eslick GD, Craig JC, McLean AS. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis. 2007;7(3):210–7.CrossRefGoogle Scholar
  18. 18.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefGoogle Scholar
  19. 19.
    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.CrossRefGoogle Scholar
  20. 20.
    Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999;27(2):97–132 (quiz 3-4; discussion 96).CrossRefGoogle Scholar
  21. 21.
    Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138(1):8–13.CrossRefGoogle Scholar
  22. 22.
    Pratt WB, Maithel SK, Vanounou T, Huang ZS, Callery MP, Vollmer CM Jr. Clinical and economic validation of the International Study Group of Pancreatic Fistula (ISGPF) classification scheme. Ann Surg. 2007;245(3):443–51.CrossRefGoogle Scholar
  23. 23.
    Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 2017;161(3):584–91.CrossRefGoogle Scholar
  24. 24.
    Mansukhani V, Desai G, Shah R, Jagannath P. The role of preoperative C-reactive protein and procalcitonin as predictors of post-pancreaticoduodenectomy infective complications: a prospective observational study. Indian J Gastroenterol. 2017;36(4):289–95.CrossRefGoogle Scholar
  25. 25.
    Bianchi RA, Haedo AS, Romero MC. Role of plasma procalcitonin determination in the postoperative follow-up of cephalic pancreatoduodenectomy. Cir Esp. 2006;79(6):356–60.CrossRefGoogle Scholar
  26. 26.
    Lenschow C, Hummel R, Lindner K, Mardin WA, Senninger N, Wolters H, et al. Procalcitonin—a marker for anastomotic insufficiency after pancreatoduodenectomy? Clin Lab. 2016;62(1–2):209–17.Google Scholar
  27. 27.
    Giardino A, Spolverato G, Regi P, Frigerio I, Scopelliti F, Girelli R, et al. C-reactive protein and procalcitonin as predictors of postoperative inflammatory complications after pancreatic surgery. J Gastrointest Surg. 2016;20(8):1482–92.CrossRefGoogle Scholar
  28. 28.
    Reith HB, Mittelkotter U, Debus ES, Kussner C, Thiede A. Procalcitonin in early detection of postoperative complications. Dig Surg. 1998;15(3):260–5.CrossRefGoogle Scholar
  29. 29.
    Takakura Y, Hinoi T, Egi H, Shimomura M, Adachi T, Saito Y, et al. Procalcitonin as a predictive marker for surgical site infection in elective colorectal cancer surgery. Langenbecks Arch Surg. 2013;398(6):833–9.CrossRefGoogle Scholar
  30. 30.
    Giaccaglia V, Salvi PF, Antonelli MS, Nigri G, Pirozzi F, Casagranda B, et al. Procalcitonin reveals early dehiscence in colorectal surgery: the PREDICS study. Ann Surg. 2016;263(5):967–72.CrossRefGoogle Scholar
  31. 31.
    Munoz JL, Ruiz-Tovar J, Miranda E, Berrio DL, Moya P, Gutierrez M, et al. C-reactive protein and procalcitonin as early markers of septic complications after laparoscopic sleeve gastrectomy in morbidly obese patients within an enhanced recovery after surgery program. J Am Coll Surg. 2016;222(5):831–7.CrossRefGoogle Scholar
  32. 32.
    Wang T, Wang H, Yang DL, Jiang LQ, Zhang LJ, Ding WY. Factors predicting surgical site infection after posterior lumbar surgery: a multicenter retrospective study. Medicine (Baltimore). 2017;96(5):e6042.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Hiroya Iida
    • 1
    Email author
  • Hiromitsu Maehira
    • 1
  • Haruki Mori
    • 1
  • Masaji Tani
    • 1
  1. 1.Department of SurgeryShiga University of Medical ScienceOtsuJapan

Personalised recommendations