Procalcitonin ratio as a predictor of successful surgical treatment of severe necrotizing soft tissue infections
Abstract Background Necrotizing soft tissue infections often are characterized by fulminant presentation and lethal outcomes. Besides critical care support and antibiotic therapy, aggressive surgical treatment is important for the therapy of necrotizing fasciitis. The aim of this study was to develo...
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| Veröffentlicht in: | The American journal of surgery 2013-09, Vol.206 (3), p.368-373 |
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| creator | Friederichs, Jan, M.D Hutter, Martin, M.D Hierholzer, Christian, M.D Novotny, Alexander, M.D Friess, Helmut, M.D Bühren, Volker, M.D Hungerer, Sven, M.D |
| description | Abstract Background Necrotizing soft tissue infections often are characterized by fulminant presentation and lethal outcomes. Besides critical care support and antibiotic therapy, aggressive surgical treatment is important for the therapy of necrotizing fasciitis. The aim of this study was to develop a procalcitonin (PCT) ratio indicating successful surgical intervention. Methods The study group consisted of 38 patients treated with clinical signs of sepsis caused by a necrotizing soft tissue infection. All patients received radical surgical treatment, and serum levels of PCT and C-reactive protein were monitored postoperatively. The ratio of day 1 to day 2 was calculated and correlated with the successful elimination of the infectious source and clinical recovery. Results An eradication of the infectious focus was successfully performed in 84% of patients, averaging 1.9 operations (range 1 to 6) to achieve an elimination of the infectious source. The PCT ratio was significantly higher in the group of patients with successful surgical intervention (1.665 vs .9, P |
| doi_str_mv | 10.1016/j.amjsurg.2012.11.024 |
| format | Article |
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Besides critical care support and antibiotic therapy, aggressive surgical treatment is important for the therapy of necrotizing fasciitis. The aim of this study was to develop a procalcitonin (PCT) ratio indicating successful surgical intervention. Methods The study group consisted of 38 patients treated with clinical signs of sepsis caused by a necrotizing soft tissue infection. All patients received radical surgical treatment, and serum levels of PCT and C-reactive protein were monitored postoperatively. The ratio of day 1 to day 2 was calculated and correlated with the successful elimination of the infectious source and clinical recovery. Results An eradication of the infectious focus was successfully performed in 84% of patients, averaging 1.9 operations (range 1 to 6) to achieve an elimination of the infectious source. The PCT ratio was significantly higher in the group of patients with successful surgical intervention (1.665 vs .9, P < .001). A ratio higher than the calculated cutoff of 1.14 indicated successful surgical treatment with a sensitivity of 83.3% and a specificity of 71.4%. The positive predictive value was 75.8%, and the negative predictive value was 80.0%. Conclusions The PCT ratio of postoperative day 1 to day 2 following major surgical procedures for necrotizing soft tissue infections represents a valuable clinical tool indicating successful surgical eradication of the infectious focus.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2012.11.024</identifier><identifier>PMID: 23806825</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Age ; Aged ; Aged, 80 and over ; Amputation ; Antibiotics ; Bacterial infections ; C-Reactive Protein - metabolism ; Calcitonin - blood ; Calcitonin Gene-Related Peptide ; Chi-Square Distribution ; Fasciitis, Necrotizing - blood ; Fasciitis, Necrotizing - microbiology ; Fasciitis, Necrotizing - surgery ; Female ; Humans ; Infections ; Insect bites ; Intensive care ; Male ; Middle Aged ; Mortality ; Necrotizing fasciitis ; Necrotizing soft tissue infection ; Predictive Value of Tests ; Procalcitonin ; Protein Precursors - blood ; ROC Curve ; Sepsis ; Soft Tissue Infections - blood ; Soft Tissue Infections - microbiology ; Soft Tissue Infections - surgery ; Statistics, Nonparametric ; Surgery ; Treatment Outcome</subject><ispartof>The American journal of surgery, 2013-09, Vol.206 (3), p.368-373</ispartof><rights>Elsevier Inc.</rights><rights>2013 Elsevier Inc.</rights><rights>Copyright © 2013 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Sep 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c448t-108591cab7babdd2b77363b88dd097f98f5a1693b59e75f9fdf9e621f9d066bf3</citedby><cites>FETCH-LOGICAL-c448t-108591cab7babdd2b77363b88dd097f98f5a1693b59e75f9fdf9e621f9d066bf3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1425509233?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,45974,64362,64364,64366,72216</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23806825$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Friederichs, Jan, M.D</creatorcontrib><creatorcontrib>Hutter, Martin, M.D</creatorcontrib><creatorcontrib>Hierholzer, Christian, M.D</creatorcontrib><creatorcontrib>Novotny, Alexander, M.D</creatorcontrib><creatorcontrib>Friess, Helmut, M.D</creatorcontrib><creatorcontrib>Bühren, Volker, M.D</creatorcontrib><creatorcontrib>Hungerer, Sven, M.D</creatorcontrib><title>Procalcitonin ratio as a predictor of successful surgical treatment of severe necrotizing soft tissue infections</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Abstract Background Necrotizing soft tissue infections often are characterized by fulminant presentation and lethal outcomes. Besides critical care support and antibiotic therapy, aggressive surgical treatment is important for the therapy of necrotizing fasciitis. The aim of this study was to develop a procalcitonin (PCT) ratio indicating successful surgical intervention. Methods The study group consisted of 38 patients treated with clinical signs of sepsis caused by a necrotizing soft tissue infection. All patients received radical surgical treatment, and serum levels of PCT and C-reactive protein were monitored postoperatively. The ratio of day 1 to day 2 was calculated and correlated with the successful elimination of the infectious source and clinical recovery. Results An eradication of the infectious focus was successfully performed in 84% of patients, averaging 1.9 operations (range 1 to 6) to achieve an elimination of the infectious source. The PCT ratio was significantly higher in the group of patients with successful surgical intervention (1.665 vs .9, P < .001). A ratio higher than the calculated cutoff of 1.14 indicated successful surgical treatment with a sensitivity of 83.3% and a specificity of 71.4%. The positive predictive value was 75.8%, and the negative predictive value was 80.0%. Conclusions The PCT ratio of postoperative day 1 to day 2 following major surgical procedures for necrotizing soft tissue infections represents a valuable clinical tool indicating successful surgical eradication of the infectious focus.</description><subject>Adult</subject><subject>Age</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Amputation</subject><subject>Antibiotics</subject><subject>Bacterial infections</subject><subject>C-Reactive Protein - metabolism</subject><subject>Calcitonin - blood</subject><subject>Calcitonin Gene-Related Peptide</subject><subject>Chi-Square Distribution</subject><subject>Fasciitis, Necrotizing - blood</subject><subject>Fasciitis, Necrotizing - microbiology</subject><subject>Fasciitis, Necrotizing - surgery</subject><subject>Female</subject><subject>Humans</subject><subject>Infections</subject><subject>Insect bites</subject><subject>Intensive care</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Necrotizing fasciitis</subject><subject>Necrotizing soft tissue infection</subject><subject>Predictive Value of Tests</subject><subject>Procalcitonin</subject><subject>Protein Precursors - blood</subject><subject>ROC Curve</subject><subject>Sepsis</subject><subject>Soft Tissue Infections - blood</subject><subject>Soft Tissue Infections - microbiology</subject><subject>Soft Tissue Infections - surgery</subject><subject>Statistics, Nonparametric</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkk-LFDEQxRtR3NnVj6AEvHjpNpX0n-SiyKKrsKCgnkM6XVnS9iRjkl5YP71pZ1TYi6ck8KtXefWqqp4BbYBC_2pu9H5Oa7xpGAXWADSUtQ-qHYhB1iAEf1jtKKWslj3Qs-o8pbk8AVr-uDpjXNBesG5XHT7HYPRiXA7eeRJ1doHoRDQ5RJycySGSYElajcGU7LqQracrJSRH1HmPPv8G8BYjEo8mhux-On9DUrCZZJfSisR5i6ZI-_SkemT1kvDp6byovr1_9_XyQ3396erj5dvr2rStyDVQ0UkwehxGPU4TG4eB93wUYpqoHKwUttPQSz52EofOSjtZiT0DKyfa96PlF9XLo-4hhh8rpqz2LhlcFu0xrElBy_qho4zzgr64h85hjb78bqO6jsoj1R2p4jCliFYdotvreKeAqi0SNatTJGqLRAGoEkmpe35SX8c9Tn-r_mRQgDdHAMs4bh1GlYxDb8r4YxmamoL7b4vX9xTM4vwW0ne8w_TPjUpMUfVl24ttLYCXiyjefgHMELaB</recordid><startdate>20130901</startdate><enddate>20130901</enddate><creator>Friederichs, Jan, M.D</creator><creator>Hutter, Martin, M.D</creator><creator>Hierholzer, Christian, M.D</creator><creator>Novotny, Alexander, M.D</creator><creator>Friess, Helmut, M.D</creator><creator>Bühren, Volker, M.D</creator><creator>Hungerer, Sven, M.D</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20130901</creationdate><title>Procalcitonin ratio as a predictor of successful surgical treatment of severe necrotizing soft tissue infections</title><author>Friederichs, Jan, M.D ; Hutter, Martin, M.D ; Hierholzer, Christian, M.D ; Novotny, Alexander, M.D ; Friess, Helmut, M.D ; Bühren, Volker, M.D ; Hungerer, Sven, M.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c448t-108591cab7babdd2b77363b88dd097f98f5a1693b59e75f9fdf9e621f9d066bf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Age</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Amputation</topic><topic>Antibiotics</topic><topic>Bacterial infections</topic><topic>C-Reactive Protein - metabolism</topic><topic>Calcitonin - blood</topic><topic>Calcitonin Gene-Related Peptide</topic><topic>Chi-Square Distribution</topic><topic>Fasciitis, Necrotizing - blood</topic><topic>Fasciitis, Necrotizing - microbiology</topic><topic>Fasciitis, Necrotizing - surgery</topic><topic>Female</topic><topic>Humans</topic><topic>Infections</topic><topic>Insect bites</topic><topic>Intensive care</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Necrotizing fasciitis</topic><topic>Necrotizing soft tissue infection</topic><topic>Predictive Value of Tests</topic><topic>Procalcitonin</topic><topic>Protein Precursors - blood</topic><topic>ROC Curve</topic><topic>Sepsis</topic><topic>Soft Tissue Infections - blood</topic><topic>Soft Tissue Infections - microbiology</topic><topic>Soft Tissue Infections - surgery</topic><topic>Statistics, Nonparametric</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Friederichs, Jan, M.D</creatorcontrib><creatorcontrib>Hutter, Martin, M.D</creatorcontrib><creatorcontrib>Hierholzer, Christian, M.D</creatorcontrib><creatorcontrib>Novotny, Alexander, M.D</creatorcontrib><creatorcontrib>Friess, Helmut, M.D</creatorcontrib><creatorcontrib>Bühren, Volker, M.D</creatorcontrib><creatorcontrib>Hungerer, Sven, M.D</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Friederichs, Jan, M.D</au><au>Hutter, Martin, M.D</au><au>Hierholzer, Christian, M.D</au><au>Novotny, Alexander, M.D</au><au>Friess, Helmut, M.D</au><au>Bühren, Volker, M.D</au><au>Hungerer, Sven, M.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Procalcitonin ratio as a predictor of successful surgical treatment of severe necrotizing soft tissue infections</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>2013-09-01</date><risdate>2013</risdate><volume>206</volume><issue>3</issue><spage>368</spage><epage>373</epage><pages>368-373</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><abstract>Abstract Background Necrotizing soft tissue infections often are characterized by fulminant presentation and lethal outcomes. Besides critical care support and antibiotic therapy, aggressive surgical treatment is important for the therapy of necrotizing fasciitis. The aim of this study was to develop a procalcitonin (PCT) ratio indicating successful surgical intervention. Methods The study group consisted of 38 patients treated with clinical signs of sepsis caused by a necrotizing soft tissue infection. All patients received radical surgical treatment, and serum levels of PCT and C-reactive protein were monitored postoperatively. The ratio of day 1 to day 2 was calculated and correlated with the successful elimination of the infectious source and clinical recovery. Results An eradication of the infectious focus was successfully performed in 84% of patients, averaging 1.9 operations (range 1 to 6) to achieve an elimination of the infectious source. The PCT ratio was significantly higher in the group of patients with successful surgical intervention (1.665 vs .9, P < .001). A ratio higher than the calculated cutoff of 1.14 indicated successful surgical treatment with a sensitivity of 83.3% and a specificity of 71.4%. The positive predictive value was 75.8%, and the negative predictive value was 80.0%. Conclusions The PCT ratio of postoperative day 1 to day 2 following major surgical procedures for necrotizing soft tissue infections represents a valuable clinical tool indicating successful surgical eradication of the infectious focus.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>23806825</pmid><doi>10.1016/j.amjsurg.2012.11.024</doi><tpages>6</tpages></addata></record> |
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| subjects | Adult Age Aged Aged, 80 and over Amputation Antibiotics Bacterial infections C-Reactive Protein - metabolism Calcitonin - blood Calcitonin Gene-Related Peptide Chi-Square Distribution Fasciitis, Necrotizing - blood Fasciitis, Necrotizing - microbiology Fasciitis, Necrotizing - surgery Female Humans Infections Insect bites Intensive care Male Middle Aged Mortality Necrotizing fasciitis Necrotizing soft tissue infection Predictive Value of Tests Procalcitonin Protein Precursors - blood ROC Curve Sepsis Soft Tissue Infections - blood Soft Tissue Infections - microbiology Soft Tissue Infections - surgery Statistics, Nonparametric Surgery Treatment Outcome |
| title | Procalcitonin ratio as a predictor of successful surgical treatment of severe necrotizing soft tissue infections |
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