Giaccaglia V, Salvi P F, Cunsolo G V, Sparagna A, Antonelli M S, Nigri G, Balducci G, Ziparo V
Department of Surgery, General Surgery 1 and Emergency Surgery Units, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
Department of Surgery, General Surgery 1 and Emergency Surgery Units, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
J Crit Care. 2014 Aug;29(4):528-32. doi: 10.1016/j.jcrc.2014.03.036. Epub 2014 Apr 5.
Procalcitonin (PCT) is a biomarker used to help sepsis diagnosing and monitoring and guide antibiotic therapy. Anastomotic leak (AL) after colorectal surgery is a severe complication associated with relevant short- and long-term sequelae. The aim of our study is to assess the predictive value of PCT levels to early diagnose AL after colorectal surgery.
Between September 2011 and September 2012, a series of 99 patients underwent colorectal surgery in our institution. In all cases, white blood cell (WBC) count, C-reactive protein (CRP), and PCT levels were measured in first, third, and fifth postoperative day (POD). Anastomotic leaks and all other postoperative complications were recorded.
We registered 7 ALs (7.1%). Decreased PCT levels had a significant negative predictive value (NPV) for AL in third and fifth POD (96.7% and 96.7%, respectively), compared with CRP and WBC. The best diagnostic performance was obtained with the combination of PCT and CRP measurements in third and fifth POD (area under the curve, 0.87 and 0.94, respectively). In 5th POD, PCT improves diagnosis, but not in a statistically significant way (area under the curve, 0.86).
Compared with more established biochemical values such as CRP and WBC, PCT is an earlier, more sensitive, and reliable marker of AL. Increased PCT levels in early PODs after colorectal surgery may provide a more effective way to detect AL, before clinical symptoms appear. Moreover, normal PCT values might be also a useful marker to facilitate a safe and early discharge of selected patients after colorectal surgery.
降钙素原（PCT）是一种用于辅助脓毒症诊断、监测及指导抗生素治疗的生物标志物。结直肠手术后吻合口漏（AL）是一种严重并发症，伴有相关的短期和长期后遗症。我们研究的目的是评估PCT水平对结直肠手术后早期诊断AL的预测价值。
2011年9月至2012年9月期间，我们机构对99例患者进行了结直肠手术。所有病例均在术后第1天、第3天和第5天测量白细胞（WBC）计数、C反应蛋白（CRP）和PCT水平。记录吻合口漏及所有其他术后并发症。
我们记录到7例吻合口漏（7.1%）。与CRP和WBC相比，术后第3天和第5天PCT水平降低对吻合口漏具有显著的阴性预测价值（分别为96.7%和96.7%）。术后第3天和第5天联合测量PCT和CRP可获得最佳诊断性能（曲线下面积分别为0.87和0.94）。在术后第5天，PCT改善了诊断，但差异无统计学意义（曲线下面积为0.86）。
与CRP和WBC等更成熟的生化指标相比，PCT是吻合口漏更早、更敏感且更可靠的标志物。结直肠手术后早期PCT水平升高可能为在临床症状出现前检测吻合口漏提供一种更有效的方法。此外，PCT值正常也可能是促进部分结直肠手术后患者安全、早期出院的有用标志物。
