Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Konishi T, Watanabe T, Kishimoto J, Nagawa H (2006) Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance. Ann Surg 244(5):758–763. doi:10.1097/01.sla.0000219017.78611.49

    Article  PubMed  Google Scholar 

  2. Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C (1993) High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 341(8844):515–518

    Article  PubMed  CAS  Google Scholar 

  3. Castelli GP, Pognani C, Meisner M, Stuani A, Bellomi D, Sgarbi L (2004) Procalcitonin and C-reactive protein during systemic inflammatory response syndrome, sepsis and organ dysfunction. Crit Care 8(4):R234–R242. doi:10.1186/cc2877

    Article  PubMed  Google Scholar 

  4. Mimoz O, Benoist JF, Edouard AR, Assicot M, Bohuon C, Samii K (1998) Procalcitonin and C-reactive protein during the early posttraumatic systemic inflammatory response syndrome. Intensive Care Med 24(2):185–188

    Article  PubMed  CAS  Google Scholar 

  5. Rau BM, Kemppainen EA, Gumbs AA, Buchler MW, Wegscheider K, Bassi C, Puolakkainen PA, Beger HG (2007) Early assessment of pancreatic infections and overall prognosis in severe acute pancreatitis by procalcitonin (PCT): a prospective international multicenter study. Ann Surg 245(5):745–754. doi:10.1097/01.sla.0000252443.22360.46

    Article  PubMed  Google Scholar 

  6. Ayten R, Dogru O, Camci C, Aygen E, Cetinkaya Z, Akbulut H (2005) Predictive value of procalcitonin for the diagnosis of bowel strangulation. World J Surg 29(2):187–189. doi:10.1007/s00268-004-7488-z

    Article  PubMed  Google Scholar 

  7. Markogiannakis H, Memos N, Messaris E, Dardamanis D, Larentzakis A, Papanikolaou D, Zografos GC, Manouras A (2011) Predictive value of procalcitonin for bowel ischemia and necrosis in bowel obstruction. Surgery 149(3):394–403. doi:10.1016/j.surg.2010.08.007

    Article  PubMed  Google Scholar 

  8. Papaziogas B, Anthimidis G, Koutelidakis I, Atmatzidis S, Atmatzidis K (2008) Predictive value of procalcitonin for the diagnosis of bowel strangulation. World J Surg 32(7):1566–1567, author reply 1568

    Article  PubMed  CAS  Google Scholar 

  9. Chung YG, Won YS, Kwon YJ, Shin HC, Choi CS, Yeom JS (2011) Comparison of serum CRP and procalcitonin in patients after spine surgery. J Korean Neurosurg Soc 49(1):43–48. doi:10.3340/jkns.2011.49.1.43

    Article  PubMed  CAS  Google Scholar 

  10. Hunziker S, Hugle T, Schuchardt K, Groeschl I, Schuetz P, Mueller B, Dick W, Eriksson U, Trampuz A (2010) The value of serum procalcitonin level for differentiation of infectious from noninfectious causes of fever after orthopaedic surgery. J Bone Joint Surg Am 92(1):138–148. doi:10.2106/JBJS.H.01600

    Article  PubMed  Google Scholar 

  11. Carboni GL, Fahrner R, Gazdhar A, Printzen G, Schmid RA, Hoksch B (2008) Comparison of procalcitonin and CrP in the postoperative course after lung decortication. Eur J Cardiothorac Surg 33(5):777–780. doi:10.1016/j.ejcts.2008.02.013

    Article  PubMed  Google Scholar 

  12. Nie H, Jiang D, Ou Y, Quan Z, Hao J, Bai C, Huang X, An H (2011) Procalcitonin as an early predictor of postoperative infectious complications in patients with acute traumatic spinal cord injury. Spinal Cord 49(6):715–720. doi:10.1038/sc.2010.190

    Article  PubMed  CAS  Google Scholar 

  13. Perrakis A, Yedibela S, Schellerer V, Hohenberger W, Muller V (2010) Procalcitonin in the setting of complicated postoperative course after liver transplantation. Transplant Proc 42(10):4187–4190. doi:10.1016/j.transproceed.2010.08.070

    Article  PubMed  CAS  Google Scholar 

  14. Reith HB, Mittelkotter U, Debus ES, Kussner C, Thiede A (1998) Procalcitonin in early detection of postoperative complications. Dig Surg 15(3):260–265

    Article  PubMed  CAS  Google Scholar 

  15. Novotny A, Emmanuel K, Matevossian E, Kriner M, Ulm K, Bartels H, Holzmann B, Weighardt H, Siewert JR (2007) Use of procalcitonin for early prediction of lethal outcome of postoperative sepsis. Am J Surg 194(1):35–39. doi:10.1016/j.amjsurg.2006.10.026

    Article  PubMed  CAS  Google Scholar 

  16. Aouifi A, Piriou V, Bastien O, Blanc P, Bouvier H, Evans R, Celard M, Vandenesch F, Rousson R, Lehot JJ (2000) Usefulness of procalcitonin for diagnosis of infection in cardiac surgical patients. Crit Care Med 28(9):3171–3176

    Article  PubMed  CAS  Google Scholar 

  17. Schuetz P, Muller B, Christ-Crain M, Stolz D, Tamm M, Bouadma L, Luyt CE, Wolff M, Chastre J, Tubach F, Kristoffersen KB, Burkhardt O, Welte T, Schroeder S, Nobre V, Wei L, Bhatnagar N, Bucher HC, Briel M (2012) Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev 9, CD007498. doi:10.1002/14651858.CD007498.pub2

    PubMed  Google Scholar 

  18. Wacker C, Prkno A, Brunkhorst FM, Schlattmann P (2013) Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis. doi:10.1016/S1473-3099(12)70323-7

    PubMed  Google Scholar 

  19. Dorge H, Schondube FA, Dorge P, Seipelt R, Voss M, Messmer BJ (2003) Procalcitonin is a valuable prognostic marker in cardiac surgery but not specific for infection. Thorac Cardiovasc Surg 51(6):322–326. doi:10.1055/s-2003-45425

    Article  PubMed  CAS  Google Scholar 

  20. Uchino M, Ikeuchi H, Tsuchida T, Nakajima K, Tomita N, Takesue Y (2009) Surgical site infection following surgery for inflammatory bowel disease in patients with clean-contaminated wounds. World J Surg 33(5):1042–1048. doi:10.1007/s00268-009-9934-4

    Article  PubMed  Google Scholar 

  21. Meisner M, Lohs T, Huettemann E, Schmidt J, Hueller M, Reinhart K (2001) The plasma elimination rate and urinary secretion of procalcitonin in patients with normal and impaired renal function. Eur J Anaesthesiol 18(2):79–87

    PubMed  CAS  Google Scholar 

  22. Rau BM, Frigerio I, Buchler MW, Wegscheider K, Bassi C, Puolakkainen PA, Beger HG, Schilling MK (2007) Evaluation of procalcitonin for predicting septic multiorgan failure and overall prognosis in secondary peritonitis: a prospective, international multicenter study. Arch Surg 142(2):134–142. doi:10.1001/archsurg.142.2.134

    Article  PubMed  CAS  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Surgery, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Yuji Takakura, Takao Hinoi, Hiroyuki Egi, Manabu Shimomura, Tomohiro Adachi, Yasufumi Saito, Naoki Tanimine, Masashi Miguchi & Hideki Ohdan

  2. Department of Gastrointestinal Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan

    Yuji Takakura

Authors
  1. Yuji Takakura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takao Hinoi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroyuki Egi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Manabu Shimomura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tomohiro Adachi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yasufumi Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Naoki Tanimine
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Masashi Miguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hideki Ohdan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yuji Takakura.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Takakura, Y., Hinoi, T., Egi, H. et al. Procalcitonin as a predictive marker for surgical site infection in elective colorectal cancer surgery. Langenbecks Arch Surg 398, 833–839 (2013). https://doi.org/10.1007/s00423-013-1095-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-013-1095-0

Keywords

Search

Navigation