title: Procalcitonin levels predict infectious complications and response to treatment in patients undergoing cytoreductive surgery for peritoneal malignancy.
abstract: BACKGROUND
  Cytoreductive-surgery for peritoneal-malignancy (PM) involves extensive intra-abdominal surgery and a massive post-operative systemic-inflammatory-response (SIRS). It is often challenging to differentiate SIRS that are solely surgery-associated from those of post-operative infections. White-Cell-Counts (WCC) and C-Reactive-Protein (CRP) are routinely used as markers for infection, but are non-specific and their elevation is often delayed in PM cases. Other markers need to be evaluated to assist early identification/prediction of post-operative infections.
  
  
  METHODS
  Prospective evaluation of serum procalcitonin (PCT), CRP and WCC in 50 patients pre-operatively (Day0), and on post-operative days (POD) 1, 3 & 6, following cytoreductive-surgery with or without splenectomy.
  
  
  RESULTS
  Day0 PCT, CRP and WCC values were within normal limits, but increasing physiologically in post-operative period without infection, with noticeable higher PCT in splenectomized patients. In our cohort post-operative infections were diagnosed in 14 patients, often within 48 h. There was a trend for faster rise in serum PCT on POD1 compared to CRP and WCC, and faster PCT decline following appropriate therapy on POD3 and POD6 when infected cases were clinically resolving while WCC and CRP continued to rise, particularly in non-spelenectomised patients. The AUC on POD1 was significantly higher for PCT (0.689) vs. WCC (0.476) and CRP (0.477) (p = 0.04). Sensitivity, specificity, positive-predictive-value and negative-predictive-values for PCT ranged between (57%-100%), (22%-74%), (33%-47%) & (81%-100%), for CRP (28%-78%), (5.5%-86%), (18%-44.4%) & (40%-75.5%) and for WCC (14%-26.5%), (65.5-80.5%), (22%-25%), (67%-70%) respectively.
  
  
  CONCLUSIONS
  PCT, like WCC and CRP, needs to be interpreted with extreme cautions in the context of infections post-cytoreductive-surgery and should only be used in association with other clinical and investigational findings.
authors.affiliation: Department of Microbiology, Hampshire Hospitals NHS Foundation Trusts (Basingstoke and Winchester), Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK; University of Southampton Medical School, Tremona Road, Southampton, SO16 6YD, UK. Electronic address: kordosaeed@nhs.net.
authors.forename: K
authors.initials: K
authors.lastname: Saeed
authors.affiliation: Department of Microbiology, Hampshire Hospitals NHS Foundation Trusts (Basingstoke and Winchester), Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK.
authors.forename: A P
authors.initials: AP
authors.lastname: Dale
authors.affiliation: Department of Surgery and Pseudomixoma Surgery, Hampshire Hospitals NHS Foundation Trusts, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK.
authors.forename: E
authors.initials: E
authors.lastname: Leung
authors.affiliation: Department of Microbiology, Hampshire Hospitals NHS Foundation Trusts (Basingstoke and Winchester), Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK.
authors.forename: T
authors.initials: T
authors.lastname: Cusack
authors.affiliation: Department of Surgery and Pseudomixoma Surgery, Hampshire Hospitals NHS Foundation Trusts, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK.
authors.forename: F
authors.initials: F
authors.lastname: Mohamed
authors.affiliation: Department of Microbiology, Hampshire Hospitals NHS Foundation Trusts (Basingstoke and Winchester), Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK.
authors.forename: G
authors.initials: G
authors.lastname: Lockyer
authors.affiliation: Department of Surgery and Pseudomixoma Surgery, Hampshire Hospitals NHS Foundation Trusts, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK.
authors.forename: S
authors.initials: S
authors.lastname: Arnaudov
authors.affiliation: Department of Intensive Care Unit, Hampshire Hospitals NHS Foundation Trusts, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK.
authors.forename: A
authors.initials: A
authors.lastname: Wade
authors.affiliation: Department of Surgery and Pseudomixoma Surgery, Hampshire Hospitals NHS Foundation Trusts, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK.
authors.forename: B
authors.initials: B
authors.lastname: Moran
authors.affiliation: Department of Microbiology, Hampshire Hospitals NHS Foundation Trusts (Basingstoke and Winchester), Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK.
authors.forename: G
authors.initials: G
authors.lastname: Lewis
authors.affiliation: Department of Microbiology, Hampshire Hospitals NHS Foundation Trusts (Basingstoke and Winchester), Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK; University of Southampton Medical School, Tremona Road, Southampton, SO16 6YD, UK.
authors.forename: M
authors.initials: M
authors.lastname: Dryden
authors.affiliation: Department of Surgery and Pseudomixoma Surgery, Hampshire Hospitals NHS Foundation Trusts, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK.
authors.forename: T
authors.initials: T
authors.lastname: Cecil
authors.affiliation: Department of Microbiology, Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, Surrey, KT2 7QB, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Cepeda
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007239:Infections / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D059413:Intraabdominal Infections / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000097:blood / Q000601:surgery*; D018410:Pneumonia, Bacterial / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D018805:Sepsis / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D013156:Splenectomy / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D013997:Time Factors
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide
keywords: Cytoreductive surgery; Peritoneal malignancy; Procalcitonin