title: Procalcitonin biomarker kinetics fails to predict treatment response in perioperative abdominal infection with septic shock.
abstract: BACKGROUND
  Procalcitonin (PCT) biomarker is suggested to tailor antibiotic therapy in the medical intensive care unit (ICU) but studies in perioperative medicine are scarce. The aim of this study was to determine whether PCT reported thresholds are associated with the initial treatment response in perioperative septic shock secondary to intra-abdominal infection.
  
  
  METHODS
  This single ICU, observational study included patients with perioperative septic shocks secondary to intra-abdominal infection. Demographics, PCT at days 0, 1, 3, 5, treatment response and outcome were collected. Treatment failure included death related to the initial infection, second source control treatment or a new onset intra-abdominal infection. The primary endpoint was to assess whether PCT thresholds (0.5 ng/ml or a drop from the peak of at least 80%) predict the initial treatment response.
  
  
  RESULTS
  We included 101 consecutive cases. Initial treatment failed in 36 patients with a subsequent mortality of 75%. Upon admission, PCT was doubled when treatment ultimately failed (21.7 ng/ml ± 38.7 vs. 41.7 ng/ml ± 75.7; P = 0.04). Although 95% of the patients in whom PCT dropped down below 0.5 ng/ml responded to treatment, 50% of the patients in whom PCT remained above 0.5 ng/ml also responded successfully to treatment. Moreover, despite a PCT drop of at least 80%, 40% of patients had treatment failure.
  
  
  CONCLUSIONS
  In perioperative intra-abdominal infections with shock, PCT decrease to 0.5 ng/ml lacked sensitivity to predict treatment response and its decrease of at least 80% from its peak failed to accurately predict treatment response. Studies in perioperative severe infections are needed before using PCT to tailor antibiotic use in this population.
authors.forename: Boris
authors.initials: B
authors.lastname: Jung
authors.forename: Nicolas
authors.initials: N
authors.lastname: Molinari
authors.forename: Mourad
authors.initials: M
authors.lastname: Nasri
authors.forename: Zied
authors.initials: Z
authors.lastname: Hajjej
authors.forename: Gerald
authors.initials: G
authors.lastname: Chanques
authors.forename: Helene
authors.initials: H
authors.lastname: Jean-Pierre
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Panaro
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006801:Humans; D059413:Intraabdominal Infections / Q000097:blood / Q000188:drug therapy*; D008297:Male; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*; D012772:Shock, Septic / Q000097:blood / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide