title: Procalcitonin ratio and on-demand relaparotomy for septic peritonitis: validation of the focus index (FI).
abstract: OBJECTIVE
  Secondary peritonitis remains challenging to manage and some recent evidence suggests that on-demand relaparotomy is more appropriate than planned relaparotomy. This study was designed to validate the predictive power of postoperative procalcitonin (PCT) changes in relation to elimination of the septic abdominal focus.
  
  
  METHODS
  In this prospective trial, postoperative PCT serum levels were monitored in 234 surgical patients with secondary peritonitis. The PCT ratio on postoperative days (PODs) 1 and 2 (focus index; FI) was calculated and correlated with the success of the operation.
  
  
  RESULTS
  A cutoff value of 1.1 was calculated for the FI. Values below 1.1 indicated insufficient elimination of the focus and values above 1.1 correlated with effective treatment. The optimal time for first PCT sampling was found to be 12-24 h after the index operation. After the respective data cleanup, successful elimination of the intraabdominal focus could be confirmed, with a sensitivity of 93 % and a specificity of 71 %.
  
  
  CONCLUSIONS
  The FI is a single parameter-based reliable predictor of successful surgical eradication and strengthens the on-demand relaparotomy concept as the method of choice to treat secondary peritonitis.
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany. volker.assfalg@tum.de.
authors.forename: Volker
authors.initials: V
authors.lastname: Assfalg
authors.affiliation: Institute of Medical Statistics and Epidemiology (IMSE), Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Wolf
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Reim
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Hüser
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Hellbrügge
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany.
authors.forename: Edouard
authors.initials: E
authors.lastname: Matevossian
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Friess
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Holzmann
authors.affiliation: Department of Surgery, Salzburger Landeskliniken, University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria.|Department of Surgery, Krankenhaus der Barmherzigen Schwestern Linz, Seilerstätte 4, 4020, Linz, Austria.
authors.forename: Klaus L
authors.initials: KL
authors.lastname: Emmanuel
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Novotny
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D006801:Humans; D007813:Laparotomy / Q000379:methods*; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010538:Peritonitis / Q000175:diagnosis* / Q000601:surgery*; D011184:Postoperative Period; D011446:Prospective Studies; D012086:Reoperation
chemical_list: D015415:Biomarkers; D002116:Calcitonin
keywords: Focus index; On-demand relaparotomy; PCT; Peritonitis; Procalcitonin; Sepsis