title: Prediction of procalcitonin for postoperative intraabdominal infections after definitive operation of intestinal fistulae.
abstract: Inflammatory biomarkers usually start to rise earlier before the infection becomes clinically evident. This study was designed to evaluate the predictive performance of procalcitonin (PCT), C-reactive protein (CRP), and white blood cell (WBC) counts in postoperative intraabdominal infections (IAIs) after definitive operation of intestinal fistulae.
  
  
  
  We prospectively enrolled a total of 356 consecutive patients who underwent elective digestive tract reconstruction for gastrointestinal fistulae without existing clinical infection. Plasma PCT levels, serum CRP concentration, and WBC counts were assessed preoperatively and on postoperative days (PODs) 1, 3, 5, and 7. The predictive value of each laboratory marker for IAIs was calculated.
  
  
  
  The occurrence rate of IAIs after elective digestive tract reconstruction for gastrointestinal fistulae in our study was 7.3%. Both PCT levels and WBC counts were significantly higher in patients with IAIs than those in patients without IAIs on POD 1, POD 3, and POD 5, whereas CRP levels differed significantly on POD 3 and POD 5. Receiver-operating characteristics demonstrated that PCT on POD 3 had the highest diagnostic accuracy for IAIs, and the area under the curve reached 0.86, with a sensitivity of 92.0% and specificity of 74.0%.
  
  
  
  The value of PCT above 0.98 ng/L on POD 3 and 0.83 ng/L on POD 5 could predict the occurrence of IAIs after definitive operations for intestinal fistulae.
authors.affiliation: Department of Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Huajian
authors.initials: H
authors.lastname: Ren
authors.affiliation: Department of Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Surgery, Medical School of Southeast University, Nanjing, Jiangsu, China; Department of Surgery, Medical School of Nanjing University, Nanjing, Jiangsu, China. Electronic address: JiananR@gmail.com.
authors.forename: Jianan
authors.initials: J
authors.lastname: Ren
authors.affiliation: Department of Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Surgery, Medical School of Southeast University, Nanjing, Jiangsu, China.
authors.forename: Qiongyuan
authors.initials: Q
authors.lastname: Hu
authors.affiliation: Department of Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Surgery, Medical School of Southeast University, Nanjing, Jiangsu, China; Department of Surgery, Medical School of Nanjing University, Nanjing, Jiangsu, China.
authors.forename: Gefei
authors.initials: G
authors.lastname: Wang
authors.affiliation: Department of Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Guosheng
authors.initials: G
authors.lastname: Gu
authors.affiliation: Department of Surgery, Medical School of Nanjing University, Nanjing, Jiangsu, China.
authors.forename: Guanwei
authors.initials: G
authors.lastname: Li
authors.affiliation: Department of Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Xiuwen
authors.initials: X
authors.lastname: Wu
authors.affiliation: Department of Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Zhiwu
authors.initials: Z
authors.lastname: Hong
authors.affiliation: Department of Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Jieshou
authors.initials: J
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002116:Calcitonin / Q000097:blood*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000601:surgery*; D059413:Intraabdominal Infections / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002116:Calcitonin; D002097:C-Reactive Protein
keywords: Intestinal fistulae surgery; Intraabdominal infections; Procalcitonin