Procalcitonin: improved biochemical severity stratification and postoperative monitoring in severe abdominal inflammation and sepsis.
BACKGROUND
Infections and sepsis are among the most devastating complications in abdominal surgery and significantly contribute to morbidity and mortality. Early and reliable diagnosis of septic complications is notoriously difficult, and the search for novel approaches to overcome this problem is still a compelling issue for clinicians. Among a large array of inflammatory parameters, procalcitonin (PCT), the 116-amino-acid pro-peptide of calcitonin, has gained considerable importance in identifying patients at risk of developing infection and sepsis in clinical practice.


METHODS
Along with the latest insights into pathophysiological aspects of this pro-hormone, the literature as well as our own experience on the usefulness of PCT determinations in patients with severe inflammatory abdominal disorders was reviewed.


RESULTS
Although the term "sepsis" does not embrace the integral properties of PCT, a remarkable number of clinical studies have demonstrated the pivotal role of this parameter in the host response to microbial and fungal infections. In acute pancreatitis PCT allows early severity stratification and closely correlates with the development of subsequent pancreatic infections. In patients with peritonitis PCT reflects overall disease severity and is an early and reliable indicator of overall prognosis. Postoperative monitoring of PCT is a helpful tool to identify patients with evolving or persisting septic complications after elective and emergency abdominal surgery.


CONCLUSIONS
Compared with established biochemical routine variables, PCT significantly contributes to earlier and better stratification of patients at risk of developing septic complications and provides excellent prognostic assessment in severe abdominal inflammation. The currently available test systems render PCT an applicable and readily available parameter under clinical routine and emergency conditions.
Department of General, Visceral, and Vascular Surgery, University of the Saarland, Kirrberger Strasse, 66421 Homburg/Saar, Germany. bettina.rau@uniklinik-saarland.de
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Rau
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Krüger
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Schilling
D000005:Abdomen / Q000503:physiopathology* / Q000601:surgery; D002116:Calcitonin / Q000502:physiology*; D015740:Calcitonin Gene-Related Peptide; D006801:Humans; D010538:Peritonitis / Q000503:physiopathology*; D011498:Protein Precursors / Q000502:physiology*; D018805:Sepsis / Q000503:physiopathology*; D013514:Surgical Procedures, Operative / Q000009:adverse effects*
C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide