Procalcitonin as an early predictor of postoperative infectious complications in patients with acute traumatic spinal cord injury.
METHODS
Prospective, nonrandomized, observational cohort study.


OBJECTIVE
To analyze procalcitonin (PCT) level in acute traumatic spinal cord injury patients with and without postoperative infectious complications, and to determine whether PCT is a prognostic parameter of infectious complications in the early postoperative period compared with other inflammatory markers.


METHODS
Spine center of Chongqing, China; Trauma center of Chinese People's Liberation Army, China.


METHODS
A total of 339 consecutive patients with acute spinal cord injury undergone surgery were evaluated. All patients underwent measurement of leukocyte count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum PCT preoperatively and 24-48 h postoperatively.


RESULTS
In all, 26 (7.7%) of 339 participants experienced postoperative infectious complication. Patients with infection exhibited significantly higher PCT and CRP levels compared with noninfection (both P<0.01). Multivariate logistic regression analysis showed that PCT and CRP levels were independent predicators for postoperative infection. The area under the receiver operating characteristics curve of PCT and CRP were 0.82 (95% confidence intervals (CI) 0.74-0.91) and 0.68 (95%CI, 0.57-0.78), respectively. A PCT cutoff of 0.1 ng ml(-1) had a reasonable sensitivity of 92% to exclude an infection and antibiotics can be initially withheld. However, in patients with PCT level above 0.5 ng ml(-1), a rapid initiation of antibiotics may be warranted.


CONCLUSIONS
Serum PCT is a more reliable biologic marker for the early prediction of postoperative infectious complications in patients with acute traumatic spinal cord injury compared with CRP. PCT can early identify postoperative infections for establishing effective antibiotic therapy.
Department of Orthopaedics, The First Affiliated Hospital, Chongqing Medical University, Spine Center of Chongqing, Chongqing, China.
H
H
Nie
D
D
Jiang
Y
Y
Ou
Z
Z
Quan
J
J
Hao
C
C
Bai
X
X
Huang
H
H
An
D000328:Adult; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000096:biosynthesis / Q000378:metabolism; D002116:Calcitonin / Q000096:biosynthesis / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000096:biosynthesis / Q000097:blood*; D013119:Spinal Cord Injuries / Q000097:blood* / Q000150:complications* / Q000601:surgery; D013530:Surgical Wound Infection / Q000097:blood* / Q000453:epidemiology / Q000209:etiology*
D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide