title: Serum procalcitonin for predicting the failure of conservative management and the need for bowel resection in patients with small bowel obstruction.
abstract: BACKGROUND
  Ischemia and necrosis are complications of small bowel obstruction (SBO) and require rapid surgical treatment. At present, there are no sufficiently accurate preoperative biomarkers of ischemia or necrosis. The objective of the current study was to evaluate the value of serum procalcitonin levels for predicting conservative management failure and the presence of intraoperatively observed bowel ischemia (reversible or not) in patients with SBO.
  
  
  METHODS
  One hundred and sixty-six participants of 242 in a randomized controlled trial focusing on the management of SBO (Acute Bowel Obstruction Diagnostic study [ABOD], NCT00389116) had available data on procalcitonin and were included in the study. The primary study objective was to determine whether serum procalcitonin could identify patients in whom conservative management (CM) failed (the surgical management [SM] group) and the subset of SM patients with intraoperatively observed ischemia (reversible or not). For the analysis, the patients were divided into subgroups according to the success or failure of CM and (for surgically managed patients) the presence or absence of intraoperative ischemia (reversible or not).
  
  
  RESULTS
  Procalcitonin levels were higher in the SM group (n = 35) than in the CM group (n = 131) (0.53 vs 0.14 ng/mL; p = 0.031) and higher in the group managed surgically with ischemia (n = 12) than patients managed surgically without intraoperative ischemia (n = 23) (1.16 vs 0.21 ng/mL, respectively; p < 0.001). A multiple logistic regression showed that procalcitonin is a risk factor for CM failure (odds ratio = 3.5; 95% CI, 1.4-8.5; p = 0.006) and for ischemia (reversible or not) (odds ratio = 46.9; 95% CI, 4.0-547.3; p < 0.001).
  
  
  CONCLUSIONS
  Procalcitonin can help predict CM failure and occurrence of bowel ischemia (reversible or not) in SBO patients, but additional studies are needed.
authors.affiliation: Department of Digestive and Metabolic Surgery, Amiens University Hospital, Amiens, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Cosse
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Regimbeau
authors.forename: David
authors.initials: D
authors.lastname: Fuks
authors.forename: François
authors.initials: F
authors.lastname: Mauvais
authors.forename: Michel
authors.initials: M
authors.lastname: Scotte
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000097:blood / Q000601:surgery* / Q000628:therapy; D007421:Intestine, Small / Q000098:blood supply* / Q000601:surgery*; D007511:Ischemia / Q000150:complications / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology / Q000517:prevention & control; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*; D016032:Randomized Controlled Trials as Topic; D017211:Treatment Failure
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide