Evaluation of procalcitonin for predicting septic multiorgan failure and overall prognosis in secondary peritonitis: a prospective, international multicenter study.
OBJECTIVE
Infections and sepsis are major complications in secondary peritonitis and still represent a diagnostic challenge. We hypothesized that the laboratory marker procalcitonin would provide an early and reliable assessment of septic complications.


METHODS
Prospective, international, multicenter inception cohort study.


METHODS
Five European surgical referral centers.


METHODS
Eighty-two patients with intraoperatively proven secondary peritonitis were enrolled within 96 hours of symptom onset.


METHODS
Procalcitonin and the laboratory routine marker C-reactive protein (CRP) were prospectively assessed and monitored for a maximum of 21 consecutive days.


RESULTS
Procalcitonin concentrations were most closely correlated with the development of septic multiorgan dysfunction syndrome (MODS), with peak levels occurring early after symptom onset or during the immediate postoperative course. No such correlation was observed for CRP. According to receiver operating characteristic analysis, a procalcitonin value of 10.0 ng/mL or greater on 2 consecutive days was superior to a CRP level of 210 mg/L or greater for predicting septic MODS, with sensitivity, specificity, and positive and negative predictive values of 65%, 92%, 83%, and 81% for procalcitonin and 67%, 58%, 49%, and 74% for CRP, respectively (P<.001). Assessment of septic MODS was already possible on the first 2 postoperative days, with similar sensitivity and specificity. Persisting procalcitonin levels greater than 1.0 ng/mL beyond the first week after disease onset strongly indicated nonsurvival and were significantly better than CRP in assessing overall prognosis (P<.001).


CONCLUSIONS
Procalcitonin monitoring is a fast and reliable approach to assessing septic MODS and overall prognosis in secondary peritonitis. This single-test marker improves stratification of patients who will develop clinically relevant complications.
Rau
Bettina M
BM
Department of General, Visceral, and Vascular Surgery, University of the Saarland, Homburg/Saar, Germany. bettina.rau@uniklinikum-saarland.de
Frigerio
Isabella
I
Büchler
Markus W
MW
Wegscheider
Karl
K
Bassi
Claudio
C
Puolakkainen
Pauli A
PA
Beger
Hans G
HG
Schilling
Martin K
MK
D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D005500:Follow-Up Studies; D006023:Glycoproteins / Q000097:blood; D006801:Humans; D008163:Luminescent Measurements; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000097:blood / Q000150:complications*; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood* / Q000209:etiology; D013997:Time Factors
C000606589:CALCA protein, human; D006023:Glycoproteins; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide