The clinical significance of serum procalcitonin levels following direct hemoperfusion with polymyxin B-immobilized fiber column in septic patients with colorectal perforation.
BACKGROUND
The efficacy of direct hemoperfusion with polymyxin B-immobilized fiber columns (PMX) has already been demonstrated in clinical studies for the treatment of septic shock. However, serum procalcitonin levels following PMX remain unknown.


METHODS
This prospective, multicenter, nonrandomized clinical study was performed at 12 institutions. Forty-five patients with severe sepsis or septic shock due to colorectal perforation underwent PMX. Patients' outcome as well as circulating levels of endotoxin, procalcitonin and IL-6 were monitored.


RESULTS
Before surgery, procalcitonin level, but not endotoxin and IL-6 levels, was elevated according to patients' septic conditions. Procalcitonin was significantly and positively correlated with sequential organ failure assessment score. Circulating levels of procalcitonin peaked 24 h after PMX treatment. Change in serum procalcitonin level was significantly higher in nonsurvivors than survivors. Nine mortalities were observed within 28 days. The best predictor for 28-day mortality was procalcitonin >85.7 ng/ml at 24 h after PMX (area under the receiver operating characteristic curve: 0.808 +/- 0.105).


CONCLUSIONS
Procalcitonin may be a good indicator of severity of sepsis secondary to colorectal perforation. Furthermore, procalcitonin level at 24 h after PMX appears to predict outcome after PMX. Therefore, procalcitonin may be a useful diagnostic marker to evaluate patients' condition in candidates for PMX treatment.
Shimizu
T
T
Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, Japan.
Hanasawa
K
K
Sato
K
K
Umeki
M
M
Koga
N
N
Naganuma
T
T
Sato
S
S
Shimonishi
T
T
Ikeda
T
T
Matsuno
N
N
Ono
S
S
Saitoh
H
H
Satoh
K
K
Otani
Y
Y
Endo
Y
Y
Eguchi
Y
Y
Tani
T
T
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D003108:Colonic Diseases / Q000150:complications*; D004731:Endotoxins / Q000097:blood; D005260:Female; D006464:Hemoperfusion; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D007416:Intestinal Perforation / Q000150:complications*; D008297:Male; D010532:Peritoneal Diseases / Q000097:blood / Q000628:therapy; D011112:Polymyxin B / Q000008:administration & dosage; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012002:Rectal Diseases / Q000150:complications*; D018805:Sepsis / Q000097:blood* / Q000628:therapy; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; C000606589:CALCA protein, human; D004731:Endotoxins; D015850:Interleukin-6; D011498:Protein Precursors; D002116:Calcitonin; D011112:Polymyxin B; D015740:Calcitonin Gene-Related Peptide