Indian Journal of Surgery

, Volume 75, Issue 2, pp 86–93 | Cite as

Value of Serum Procalcitonin in Evaluating the Prognosis of Sepsis in Elderly Patients with Colorectal Cancer Undergoing Emergency Colorectal Surgery

  • Yong Li
  • Zhao-Chen Jin
  • Yan Cai
  • Mu-Sen Ji
  • Jing Liu
Original Article


Serum procalcitonin (PCT) levels may have predictive value in the prognosis of postoperative sepsis in elderly patients who have undergone colorectal surgery for colorectal cancer in intensive care units (ICUs). A prospective study involving 90 critically ill patients who underwent colorectal surgery for colorectal cancer in ICUs was performed. Twenty-eight patients were diagnosed with sepsis, in accordance with the American College of Chest Physicians/Society of Critical Care Medicine consensus criteria, and these patients were included in the sepsis group. Sixty-two patients, who were without evidence of sepsis, were enrolled in the control group. We measured the serum PCT concentrations preoperatively (immediately before induction of anesthesia), upon arrival in the ICU (ICU day 0), on the morning of the first postoperative day (postoperative day 1), and on the morning of the third postoperative day (postoperative day 3). The C-reactive protein (CRP) index, acute physiology and chronic health evaluation II (APACHE II) score, mechanical duration of ventilation, mortality rate, incidence of multiple organ failure, and usage of continuous renal replacement therapy were evaluated. The area under the curve for the receiver operating characteristic curve (AUC-ROCC) was measured to explore the association between the serum PCT and the prognosis. In the sepsis group, 12/28 patients died (mortality rate 43 %). In the control group, 6/62 patients died (mortality rate 9.7 %). On the first postoperative day, the serum PCT level was dramatically higher in the sepsis group than in the control group (2.71 ± 1.13 vs. 1.37 ± 0.57, P ≤ 0.05). The PCT level on the first postoperative day was distinctly higher than that measured upon arrival in the ICU (2.71 ± 1.13 vs. 1.31 ± 0.58, P ≤ 0.05). In the two groups, the CRP concentrations were both markedly higher on the first postoperative day than upon arrival in the ICU (138.89 ± 45.12 vs. 70.43 ± 23.54 in the sepsis group, and 133.13 ± 44.91 vs. 69.65 ± 24.98 in the control group, P ≤ 0.05). Linear regression analysis was performed. The results suggest that the PCT and APACHE-II scores were not significantly associated. On the first and third postoperative days, the PCT levels were associated with increased odds of sepsis (AUC-ROCC, 95 % confidence interval 0.817–0.973, P = 0.000, and 0.755–0.944, P = 0.000, respectively). The outcomes of patients in the sepsis group were worse than those in the control group. PCT levels appear to be early markers of postoperative sepsis in elderly patients undergoing colorectal surgery for colorectal cancer during the ICU course. These findings could allow for early identification of postoperative septic complications and be used for prognostic evaluation of these patients.


Elderly patients Sepsis Emergency colorectal surgery Procalcitonin Prognosis 


  1. 1.
    Ohana G, Dreznik Z, Bishara N, Ram E (2008) The impact of postoperative intensive care on mortality and morbidity of elderly patients following colorectal surgery. Gerontol Pol 16:35–40Google Scholar
  2. 2.
    Smothers L, Hynan L, Fleming J, Turnage R, Simmang C, Anthony T (2003) Emergency surgery for colon carcinoma. Dis Colon Rectum 46:24–30PubMedCrossRefGoogle Scholar
  3. 3.
    Pierrakos C, Vincent JL (2010) Sepsis biomarkers: a review. Crit Care 14:R15PubMedCrossRefGoogle Scholar
  4. 4.
    Sudhir U, Venkatachalaiah RK, Kumar TA, Rao MY, Kempegowda P (2011) Significance of serum procalcitonin in sepsis. Indian J Crit Care Med 15:1–15PubMedCrossRefGoogle Scholar
  5. 5.
    Balc IC, Sungurtekin H, Gurses E, Sungurtekin U, Kaptanoglu B (2003) Usefulness of procalcitonin for diagnosis of sepsis in the intensive care unit. Crit Care 7:85–90CrossRefGoogle Scholar
  6. 6.
    Bouadma L, Luyt CE, Tubach F, Cracco C, Alvarez A, Schwebel C, Schortgen F, Lasocki S, Veber B, Dehoux M, Bernard M, Pasquet B, Regnier B, Brun-Buisson C, Chastre J, Wolff M (2010) Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet 375:463–474PubMedCrossRefGoogle Scholar
  7. 7.
    Becker KL, Snider R, Nylen ES (2008) Procalcitonin assay in systemic inflammation, infection, and sepsis: clinical utility and limitations. Crit Care Med 36:941–952PubMedCrossRefGoogle Scholar
  8. 8.
    Tang BM, Eslick GD, Craig JC, McLean AS (2007) Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis 7:210–217PubMedCrossRefGoogle Scholar
  9. 9.
    Clec'h C, Fosse JP, Karoubi P, Vincent F, Chouahi I, Hamza L, Cupa M, Cohen Y (2006) Differential diagnostic value of procalcitonin in surgical and medical patients with septic shock. Crit Care Med 34:102–107PubMedCrossRefGoogle Scholar
  10. 10.
    Mokart D, Merlin M, Sannini A, Brun JP, Delpero JR, Houvenaeghel G, Moutardier V, Blache JL (2005) Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after major surgery. Br J Anaesth 94:767–773PubMedCrossRefGoogle Scholar
  11. 11.
    American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874CrossRefGoogle Scholar
  12. 12.
    Mulcahy HE, Patchett SE, Daly L, O'Donoghue DP (1994) Prognosis of elderly patients with large bowel cancer. Br J Surg 81:736–738PubMedCrossRefGoogle Scholar
  13. 13.
    Runkel NS, Schlag P, Schwarz V, Herfarth C (1991) Outcome after emergency surgery for cancer of the large intestine. Br J Surg 78:183–188PubMedCrossRefGoogle Scholar
  14. 14.
    McGillicuddy EA, Schuster KM, Davis KA, Longo WE (2009) Factors predicting morbidity and mortality in emergency colorectal procedures in elderly patients. Arch Surg 144:1157–1162PubMedCrossRefGoogle Scholar
  15. 15.
    Namendys-Silva SA, Hernandez-Garay M, Rivero-Sigarroa E, Herrera-Gomez A (2010) Ventilator-associated pneumonia and septic shock in emergency colorectal procedures in elderly patients. Arch Surg 145:602, author reply 602–603PubMedCrossRefGoogle Scholar
  16. 16.
    Irvin GL III, Horsley JS III, Caruana JA Jr (1984) The morbidity and mortality of emergent operations for colorectal disease. Ann Surg 199:598–603PubMedCrossRefGoogle Scholar
  17. 17.
    Brunkhorst FM, Eberhard OK, Brunkhorst R (1999) Discrimination of infectious and noninfectious causes of early acute respiratory distress syndrome by procalcitonin. Crit Care Med 27:2172–2176PubMedCrossRefGoogle Scholar
  18. 18.
    Ugarte H, Silva E, Mercan D, De Mendonca A, Vincent JL (1999) Procalcitonin used as a marker of infection in the intensive care unit. Crit Care Med 27:498–504PubMedCrossRefGoogle Scholar
  19. 19.
    Luzzani A, Polati E, Dorizzi R, Rungatscher A, Pavan R, Merlini A (2003) Comparison of procalcitonin and C-reactive protein as markers of sepsis. Crit Care Med 31:1737–1741PubMedCrossRefGoogle Scholar
  20. 20.
    Muller B, Becker KL, Schachinger H, Rickenbacher PR, Huber PR, Zimmerli W, Ritz R (2000) Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med 28:977–983PubMedCrossRefGoogle Scholar
  21. 21.
    Meisner M, Tschaikowsky K, Hutzler A, Schick C, Schuttler J (1998) Postoperative plasma concentrations of procalcitonin after different types of surgery. Intensive Care Med 24:680–684PubMedCrossRefGoogle Scholar
  22. 22.
    Meisner M, Adina H, Schmidt J (2006) Correlation of procalcitonin and C-reactive protein to inflammation, complications, and outcome during the intensive care unit course of multiple-trauma patients. Crit Care 10:R1PubMedCrossRefGoogle Scholar
  23. 23.
    Muller B, White JC, Nylen ES, Snider RH, Becker KL, Habener JF (2001) Ubiquitous expression of the calcitonin-i gene in multiple tissues in response to sepsis. J Clin Endocrinol Metab 86:396–404PubMedCrossRefGoogle Scholar
  24. 24.
    Muller B, Becker KL (2001) Procalcitonin: how a hormone became a marker and mediator of sepsis. Swiss Med Wkly 131:595–602PubMedGoogle Scholar
  25. 25.
    Reith HB, Mittelkotter U, Debus ES, Kussner C, Thiede A (1998) Procalcitonin in early detection of postoperative complications. Dig Surg 15:260–265PubMedCrossRefGoogle Scholar
  26. 26.
    Chromik AM, Endter F, Uhl W, Thiede A, Reith HB, Mittelkotter U (2006) Pre-emptive antibiotic treatment vs 'standard' treatment in patients with elevated serum procalcitonin levels after elective colorectal surgery: a prospective randomised pilot study. Langenbecks Arch Surg 391:187–194PubMedCrossRefGoogle Scholar
  27. 27.
    Silvestre J, Povoa P, Coelho L, Almeida E, Moreira P, Fernandes A, Mealha R, Sabino H (2009) Is C-reactive protein a good prognostic marker in septic patients? Intensive Care Med 35:909–913PubMedCrossRefGoogle Scholar
  28. 28.
    Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 31:1250–1256PubMedCrossRefGoogle Scholar

Copyright information

© Association of Surgeons of India 2012

Authors and Affiliations

  • Yong Li
    • 1
  • Zhao-Chen Jin
    • 1
  • Yan Cai
    • 1
  • Mu-Sen Ji
    • 1
  • Jing Liu
    • 1
  1. 1.Critical Care Medicine Unit, the Affiliated People’s Hospital of Jiangsu UniversityZhen Jiang CityChina

Personalised recommendations