[Inflammatory indicators in patients after surgery of the large intestine].
OBJECTIVE
Despite recent advances in surgical techniques and intensive care management, infectious complications and sepsis remain significant problem after abdominal surgery. Therefore, inflammatory parameters were looked for that could help achieve an early and more reliable diagnosis of postoperative infections. C-reactive protein (CRP) is a nonspecific inflammatory mediator which is significantly increased postoperatively, regardless of the type of operation and the presence or absence of complications. Procalcitonin (PCT), the prohormone of calcitonin, referred to as a marker of sepsis, is increased significantly in severe bacterial and fungal infections. Quantitative PCT measurements in surgical patients have shown that postoperative PCT concentrations depend on the type and extent of surgery. PCT increased most after major abdominal surgery, although PCT concentrations were significantly higher in patients with complications compared to patients with uneventful postoperative course. The aim of the study was to determine PCT concentrations with a rapid semiquantitative PCT-Q test in the early postoperative period after colon surgery and to investigate its potential use in the diagnosis of infectious complications compared to CRP.


METHODS
Thirty-eight adult patients undergoing elective surgery of the intestine were followed up. None of the patients had clinical or laboratory signs of infection preoperatively. Leukocytes, CRP and PCT were determined preoperatively and on postoperative days 1-3 and 5. PCT was measured with the B. R. A. H. M. S PCT-Q semiquantitative test. CRP and PCT measurements in 30 patients with normal recovery were statistically analyzed.


RESULTS
CRP was significantly elevated postoperatively in all patients at the 4 time points with maximum values on postoperative day 2. There was no difference in CRP values between patients with and without complications. Although PCT concentration was increased in 15 of 30 patients with normal recovery, only mild increase (>0.5-2 ng/L) was recorded in 13, and moderate increase (>2-10 ng/L) in only two patients. PCT increase was most frequently found on postoperative day 1 or 2, and more rarely on postoperative day 3. The number of patients with elevated PCT was significantly higher (8 of 8 patients) in the group with complications, which included postoperative infections in 7 of 8 patients, than in the group without complications.


CONCLUSIONS
In the early postoperative period after major abdominal surgery, CRP is invariably increased and cannot help in recognizing infectious complications. In our study, which included a relatively small number of patients after colon surgery, PCT >2 ng/mL, as measured with semiquantitative PCT-Q test on postoperative days 1-5, or >0.5 ng/ml after postoperative day 3, was rarely recorded in patients with normal postoperative course. We conclude that PCT-Q test can be helpful in the early diagnosis of infectious complications after abdominal surgery.
Oberhofer
Dagmar
D
Zavod za anesteziologiju i intenzivno lijecenje, Zagreb, Hrvatska.
Rumenjak
Vlatko
V
Lazić
Jasenka
J
Vucić
Niksa
N
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006801:Humans; D007239:Infections / Q000175:diagnosis*; D018836:Inflammation Mediators / Q000097:blood*; D007420:Intestine, Large / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis*; D011498:Protein Precursors / Q000097:blood*
D015415:Biomarkers; C000606589:CALCA protein, human; D018836:Inflammation Mediators; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide