[Procalcitonin and PaO2/FiO2 ratio as predictors of mortality in the early postoperative period after esophagectomy].
OBJECTIVE
Predicting outcome in critical care remains difficult. One factor making the task difficult is, that the time elapsed between the onset of symptoms and admission to the intensive care unit is often unknown. The aim of this study is to evaluate the early course and predictive value of organ dysfunction monitored by Multiple Organ Dysfunction Score (MODS) and serum procalcitonin (PCT), microalbuminuria (M:Cr) following oesophageal tumor resection.


METHODS
In our prospective study, 79 patients (67 survivors, 12 non-survivors) are involved all had elective oesophageal tumour resection. MODS was monitored daily (t1, t2, t3). Serum PCT levels were determined 24 hourly (t0, t24, t48, t72). M:Cr was measured before (tp), and after surgery (t0, t6, t24, t48, t72). For statistical analysis Wilcoxon rank sum test, Mann-Whitney U test, receiver operating characteristic curve analysis and logistic regression analysis were used.


RESULTS
Significantly higher MODS were observed in patients who died. As of organ dysfunction, PaO2/FiO2 ratio was below normal and remained significantly lower in non-survivors at t1, t2, t3. Serum PCT at t0 was normal in both groups. Levels at t24 increased significantly, and values were significantly higher in non-survivors. Levels remained elevated at t48 and t72 without statistically significant difference between the two groups. Preoperative M:Cr was normal. At t0 levels increased significantly, but then at t6-72 levels returned to normal without significant differences between survivors and non-survivors.


CONCLUSIONS
The PaO2/FiO2 ratio gave clear differentiation between survivors and non-survivors. It seems to be a sensitive measurement for predicting outcome following oesophagectomy. Routine measurement of serum PCT in the postoperative period may help predicting outcome but further studies are required.
Szakmány
Tamás
T
Anaesthesiológiai és Intenzív Terápiás Intézet, Pécsi Tudományegyetem, Altalános Orvostudományi Kar, 7643 Pécs, Ifjúság u. 13.
Márton
Sándor
S
Molnár
Zsolt
Z
D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D016629:Esophagectomy / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality*; D010100:Oxygen / Q000097:blood*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis
D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide; D010100:Oxygen
Procalcitonin és PaO2/FiO2 arány, mint a mortalitás prediktorai a nyelócsómútétek korai posztoperatív szakában.