Mannan-binding lectin and procalcitonin measurement for prediction of postoperative infection.
BACKGROUND
Postoperative infection is a major cause of morbidity and mortality. We investigated two serum markers for their ability to identify patients at risk for postoperative infection. Mannan-binding lectin (MBL) is a central molecule of the innate immune system and MBL deficiency is known to predispose to infection. Procalcitonin (PCT) is a sensitive marker for bacterial infection.


METHODS
We investigated 162 patients undergoing elective surgery for cancer of the gastrointestinal tract. Patients were classified as having no complications (group A), having infection for unknown reason (group B) or having sepsis after events like aspiration or anastomotic leakage (group C). Analysis was done pre- and postoperatively for serum levels of MBL, PCT and C-reactive-protein. DNA was preoperatively sampled and stored and later analysed for genetic polymorphisms of MBL.


RESULTS
The preoperative serum levels of MBL were significantly lower in group B patients than in group A patients (1332 +/- 466 ng/ml versus 2523 +/- 181 ng/ml). PCT measured on day one post-surgery was significantly higher in group B patients than in group A (3.33 +/- 1.08 ng/ml versus 1.38 +/- 0.17 ng/ml). Patients with an aberrant MBL genotype had a significantly higher risk of postoperative infections than wild-type carriers (p < 0.05).


CONCLUSIONS
Preoperative MBL and early postoperative PCT measurement may help identify patients at risk for postoperative infection.
Siassi
Michael
M
Department of Surgery, University Hospital Erlangen, Erlangen, Germany. michael@siassi.de
Riese
Jutta
J
Steffensen
Rudi
R
Meisner
Michael
M
Thiel
Steffen
S
Hohenberger
Werner
W
Schmidt
Joachim
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D013505:Digestive System Surgical Procedures; D005260:Female; D005838:Genotype; D006801:Humans; D007239:Infections / Q000175:diagnosis*; D008297:Male; D037601:Mannose-Binding Lectin / Q000097:blood* / Q000235:genetics; D008875:Middle Aged; D010446:Peptide Fragments / Q000097:blood; D011110:Polymorphism, Genetic / Q000235:genetics; D011183:Postoperative Complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*; D018709:Statistics, Nonparametric
D015415:Biomarkers; C079903:C-reactive protein (164-173); C000606589:CALCA protein, human; D037601:Mannose-Binding Lectin; D010446:Peptide Fragments; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide