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Procalcitonin levels predict infectious complications and response to treatment in patients undergoing cytoreductive surgery for peritoneal malignancy

Procalcitonin levels predict infectious complications and response to treatment in patients undergoing cytoreductive surgery for peritoneal malignancy
Procalcitonin levels predict infectious complications and response to treatment in patients undergoing cytoreductive surgery for peritoneal malignancy
Background: Cytoreductive-surgery for peritoneal-malignancy (PM) involves extensive intra-abdominal surgery and a massive post-operative systemic–inflammatory-response (SIRS). It is often challenging to differentiate SIRS that are solely surgery-associated from those of post-operative infections. White-Cell-Counts (WCC) and C-Reactive-Protein (CRP) are routinely used as markers for infection, but are non-specific and their elevation is often delayed in PM cases. Other markers need to be evaluated to assist early identification/prediction of post-operative infections.
Methodology: Prospective evaluation of serum procalcitonin (PCT), CRP and WCC in 50 patients pre-operatively (Day0), and on post-operative days (POD) 1, 3 & 6, following cytoreductive-surgery with or without splenectomy.
Results: Day 0 PCT, CRP and WCC values were within normal limits, but increasing physiologically in post-operative period without infection, with noticeable higher PCT in splenectomized patients. In our cohort post-operative infections were diagnosed in 14 patients, often within 48 h. There was a trend for faster rise in serum PCT on POD1 compared to CRP and WCC, and faster PCT decline following appropriate therapy on POD3 and POD6 when infected cases were clinically resolving while WCC and CRP continued to rise, particularly in non-spelenectomised patients. The AUC on POD1 was significantly higher for PCT (0.689) vs. WCC (0.476) and CRP (0.477) (p = 0.04). Sensitivity, specificity, positive-predictive-value and negative-predictive-values for PCT ranged between (57%–100%), (22%–74%), (33%–47%) & (81%–100%), for CRP (28%–78%), (5.5%–86%), (18%–44.4%) & (40%–75.5%) and for WCC (14%–26.5%), (65.5–80.5%), (22%–25%), (67%–70%) respectively.
Conclusion: PCT, like WCC and CRP, needs to be interpreted with extreme cautions in the context of infections post-cytoreductive-surgery and should only be used in association with other clinical and investigational findings.
Cytoreductive surgery, Peritoneal malignancy, Procalcitonin
0748-7983
234-243
Saeed, K.
87cb67e5-71e8-4759-bf23-2ea00ebd8b39
Dale, A. P.
5096a630-1d0b-4e37-a1d4-e971e08acb54
Leung, E.
89deba98-42d9-449e-9079-d240159c4c04
Cusack, T.
426c94e1-d193-47d2-aff5-8e5726a96b86
Mohamed, F.
ec709bef-7102-4e5d-8143-7e38cc9840dd
Lockyer, G.
6d2610e3-c3eb-46c5-8625-e237b706fdf8
Arnaudov, S.
6d083fdc-f670-4175-829e-3a68f82949a2
Wade, A.
dde0ab5a-d277-4178-8ae8-d086a06eaacb
Moran, B.
ea467584-ead9-4ff7-ac50-56127518686c
Lewis, G.
82ee88ed-c8ae-4aa4-baa5-d60b223f4f90
Dryden, M.
a6c300f9-5c26-4884-980b-c098b0688ab1
Cecil, T.
737a65e0-c0d6-4760-98b9-6aebd9452828
Cepeda, J.A.
92d1a750-611a-484e-9452-392c442223dd
Saeed, K.
87cb67e5-71e8-4759-bf23-2ea00ebd8b39
Dale, A. P.
5096a630-1d0b-4e37-a1d4-e971e08acb54
Leung, E.
89deba98-42d9-449e-9079-d240159c4c04
Cusack, T.
426c94e1-d193-47d2-aff5-8e5726a96b86
Mohamed, F.
ec709bef-7102-4e5d-8143-7e38cc9840dd
Lockyer, G.
6d2610e3-c3eb-46c5-8625-e237b706fdf8
Arnaudov, S.
6d083fdc-f670-4175-829e-3a68f82949a2
Wade, A.
dde0ab5a-d277-4178-8ae8-d086a06eaacb
Moran, B.
ea467584-ead9-4ff7-ac50-56127518686c
Lewis, G.
82ee88ed-c8ae-4aa4-baa5-d60b223f4f90
Dryden, M.
a6c300f9-5c26-4884-980b-c098b0688ab1
Cecil, T.
737a65e0-c0d6-4760-98b9-6aebd9452828
Cepeda, J.A.
92d1a750-611a-484e-9452-392c442223dd

Saeed, K., Dale, A. P., Leung, E., Cusack, T., Mohamed, F., Lockyer, G., Arnaudov, S., Wade, A., Moran, B., Lewis, G., Dryden, M., Cecil, T. and Cepeda, J.A. (2016) Procalcitonin levels predict infectious complications and response to treatment in patients undergoing cytoreductive surgery for peritoneal malignancy. European Journal of Surgical Oncology, 42 (2), 234-243. (doi:10.1016/j.ejso.2015.10.004).

Record type: Article

Abstract

Background: Cytoreductive-surgery for peritoneal-malignancy (PM) involves extensive intra-abdominal surgery and a massive post-operative systemic–inflammatory-response (SIRS). It is often challenging to differentiate SIRS that are solely surgery-associated from those of post-operative infections. White-Cell-Counts (WCC) and C-Reactive-Protein (CRP) are routinely used as markers for infection, but are non-specific and their elevation is often delayed in PM cases. Other markers need to be evaluated to assist early identification/prediction of post-operative infections.
Methodology: Prospective evaluation of serum procalcitonin (PCT), CRP and WCC in 50 patients pre-operatively (Day0), and on post-operative days (POD) 1, 3 & 6, following cytoreductive-surgery with or without splenectomy.
Results: Day 0 PCT, CRP and WCC values were within normal limits, but increasing physiologically in post-operative period without infection, with noticeable higher PCT in splenectomized patients. In our cohort post-operative infections were diagnosed in 14 patients, often within 48 h. There was a trend for faster rise in serum PCT on POD1 compared to CRP and WCC, and faster PCT decline following appropriate therapy on POD3 and POD6 when infected cases were clinically resolving while WCC and CRP continued to rise, particularly in non-spelenectomised patients. The AUC on POD1 was significantly higher for PCT (0.689) vs. WCC (0.476) and CRP (0.477) (p = 0.04). Sensitivity, specificity, positive-predictive-value and negative-predictive-values for PCT ranged between (57%–100%), (22%–74%), (33%–47%) & (81%–100%), for CRP (28%–78%), (5.5%–86%), (18%–44.4%) & (40%–75.5%) and for WCC (14%–26.5%), (65.5–80.5%), (22%–25%), (67%–70%) respectively.
Conclusion: PCT, like WCC and CRP, needs to be interpreted with extreme cautions in the context of infections post-cytoreductive-surgery and should only be used in association with other clinical and investigational findings.

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More information

Published date: 1 February 2016
Additional Information: Funding Information: This study was funded by the Pseudomyxoma department at the Hampshire Hospitals NHS Foundation trust. No other funding was obtained. Publisher Copyright: © 2015 Elsevier Ltd. Copyright: Copyright 2016 Elsevier B.V., All rights reserved.
Keywords: Cytoreductive surgery, Peritoneal malignancy, Procalcitonin

Identifiers

Local EPrints ID: 447357
URI: http://eprints.soton.ac.uk/id/eprint/447357
ISSN: 0748-7983
PURE UUID: 73cc6e89-72b8-455e-a9d0-ea23f28df014
ORCID for K. Saeed: ORCID iD orcid.org/0000-0003-0123-0302
ORCID for A. P. Dale: ORCID iD orcid.org/0000-0001-8163-7481

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Date deposited: 10 Mar 2021 17:34
Last modified: 11 Mar 2022 03:00

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Contributors

Author: K. Saeed ORCID iD
Author: A. P. Dale ORCID iD
Author: E. Leung
Author: T. Cusack
Author: F. Mohamed
Author: G. Lockyer
Author: S. Arnaudov
Author: A. Wade
Author: B. Moran
Author: G. Lewis
Author: M. Dryden
Author: T. Cecil
Author: J.A. Cepeda

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