Procalcitonin, as an early biomarker of colorectal anastomotic leak, facilitates enhanced recovery after surgery
Abstract Purpose 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 predic...
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| Veröffentlicht in: | Journal of critical care 2014-08, Vol.29 (4), p.528-532 |
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| creator | Giaccaglia, V., MD Salvi, P.F., MD, PhD Cunsolo, G.V., MD Sparagna, A., MD Antonelli, M.S., MD Nigri, G., MD, PhD, FACS, FASCRS Balducci, G., MD Ziparo, V., MD |
| description | Abstract Purpose 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. Methods 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. Results 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). Conclusions 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. |
| doi_str_mv | 10.1016/j.jcrc.2014.03.036 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1536683093</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0883944114001361</els_id><sourcerecordid>3332023141</sourcerecordid><originalsourceid>FETCH-LOGICAL-c505t-cf92ffa814ba74e284aa1aff6dd61c96a2cf3e450d0f0ef6d7e5a4568ebf90963</originalsourceid><addsrcrecordid>eNp9kl9rFDEUxYModtv6BXyQgC8-dLbJ5M_MgBSkWBUKFazP4W7mRjObnazJTGG_vRm2KvRBuBASfvdwc84l5DVna864vhzWg012XTMu10yU0s_IiivVVK3m6jlZsbYVVSclPyGnOQ-M8UYI9ZKc1LLpWiH1iuy_pmghWD_F0Y8XFDKFkSKkcKAbH3eQtphodNTGEBPaCUIBIE9xFydvaUDYXlAH1gc_wYSZ4vgTRos9LXR8wHSg4Kaikef0o9zOyQsHIeOrx_OMfL_5eH_9ubq9-_Tl-sNtZRVTU2VdVzsHLZcbaCTWrQTg4Jzue81tp6G2TqBUrGeOYXluUIFUusWN61inxRl5d9Tdp_hrxjyZnc8WQ4AR45wNV0LrVrBOFPTtE3SIcxrLdAulmNa85YWqj5RNMeeEzuyTL_4cDGdmycMMZsnDLHkYJkotU7x5lJ43O-z_tvwJoADvjwAWLx48JpOtx8U_v7ht-uj_r3_1pN0GP_qS6BYPmP_9w-TaMPNt2YhlIbgsyyA0F78B-zKyrQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1535066181</pqid></control><display><type>article</type><title>Procalcitonin, as an early biomarker of colorectal anastomotic leak, facilitates enhanced recovery after surgery</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><source>ProQuest Central UK/Ireland</source><creator>Giaccaglia, V., MD ; Salvi, P.F., MD, PhD ; Cunsolo, G.V., MD ; Sparagna, A., MD ; Antonelli, M.S., MD ; Nigri, G., MD, PhD, FACS, FASCRS ; Balducci, G., MD ; Ziparo, V., MD</creator><creatorcontrib>Giaccaglia, V., MD ; Salvi, P.F., MD, PhD ; Cunsolo, G.V., MD ; Sparagna, A., MD ; Antonelli, M.S., MD ; Nigri, G., MD, PhD, FACS, FASCRS ; Balducci, G., MD ; Ziparo, V., MD</creatorcontrib><description>Abstract Purpose 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. Methods 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. Results 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). Conclusions 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.</description><identifier>ISSN: 0883-9441</identifier><identifier>EISSN: 1557-8615</identifier><identifier>DOI: 10.1016/j.jcrc.2014.03.036</identifier><identifier>PMID: 24798346</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Age ; Aged ; Anastomotic leak ; Anastomotic Leak - diagnosis ; Area Under Curve ; Bacterial infections ; Biomarkers ; Biomarkers - blood ; C-Reactive Protein - analysis ; Calcitonin - blood ; Calcitonin Gene-Related Peptide ; Chronic obstructive pulmonary disease ; Colorectal surgery ; Confidence intervals ; Critical Care ; Elective Surgical Procedures ; Enhanced recovery after surgery ; Female ; Heart attacks ; Hospitals ; Humans ; Infections ; Leukocyte Count ; Male ; Medical imaging ; Postoperative Period ; Predictive Value of Tests ; Procalcitonin ; Protein Precursors - blood ; Proteins ; Surgery</subject><ispartof>Journal of critical care, 2014-08, Vol.29 (4), p.528-532</ispartof><rights>Elsevier Inc.</rights><rights>2014 Elsevier Inc.</rights><rights>Copyright © 2014 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Aug 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c505t-cf92ffa814ba74e284aa1aff6dd61c96a2cf3e450d0f0ef6d7e5a4568ebf90963</citedby><cites>FETCH-LOGICAL-c505t-cf92ffa814ba74e284aa1aff6dd61c96a2cf3e450d0f0ef6d7e5a4568ebf90963</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1535066181?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>315,782,786,3552,27931,27932,46002,64392,64394,64396,72476</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24798346$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Giaccaglia, V., MD</creatorcontrib><creatorcontrib>Salvi, P.F., MD, PhD</creatorcontrib><creatorcontrib>Cunsolo, G.V., MD</creatorcontrib><creatorcontrib>Sparagna, A., MD</creatorcontrib><creatorcontrib>Antonelli, M.S., MD</creatorcontrib><creatorcontrib>Nigri, G., MD, PhD, FACS, FASCRS</creatorcontrib><creatorcontrib>Balducci, G., MD</creatorcontrib><creatorcontrib>Ziparo, V., MD</creatorcontrib><title>Procalcitonin, as an early biomarker of colorectal anastomotic leak, facilitates enhanced recovery after surgery</title><title>Journal of critical care</title><addtitle>J Crit Care</addtitle><description>Abstract Purpose 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. Methods 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. Results 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). Conclusions 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.</description><subject>Age</subject><subject>Aged</subject><subject>Anastomotic leak</subject><subject>Anastomotic Leak - diagnosis</subject><subject>Area Under Curve</subject><subject>Bacterial infections</subject><subject>Biomarkers</subject><subject>Biomarkers - blood</subject><subject>C-Reactive Protein - analysis</subject><subject>Calcitonin - blood</subject><subject>Calcitonin Gene-Related Peptide</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Colorectal surgery</subject><subject>Confidence intervals</subject><subject>Critical Care</subject><subject>Elective Surgical Procedures</subject><subject>Enhanced recovery after surgery</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Infections</subject><subject>Leukocyte Count</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Postoperative Period</subject><subject>Predictive Value of Tests</subject><subject>Procalcitonin</subject><subject>Protein Precursors - blood</subject><subject>Proteins</subject><subject>Surgery</subject><issn>0883-9441</issn><issn>1557-8615</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</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>eNp9kl9rFDEUxYModtv6BXyQgC8-dLbJ5M_MgBSkWBUKFazP4W7mRjObnazJTGG_vRm2KvRBuBASfvdwc84l5DVna864vhzWg012XTMu10yU0s_IiivVVK3m6jlZsbYVVSclPyGnOQ-M8UYI9ZKc1LLpWiH1iuy_pmghWD_F0Y8XFDKFkSKkcKAbH3eQtphodNTGEBPaCUIBIE9xFydvaUDYXlAH1gc_wYSZ4vgTRos9LXR8wHSg4Kaikef0o9zOyQsHIeOrx_OMfL_5eH_9ubq9-_Tl-sNtZRVTU2VdVzsHLZcbaCTWrQTg4Jzue81tp6G2TqBUrGeOYXluUIFUusWN61inxRl5d9Tdp_hrxjyZnc8WQ4AR45wNV0LrVrBOFPTtE3SIcxrLdAulmNa85YWqj5RNMeeEzuyTL_4cDGdmycMMZsnDLHkYJkotU7x5lJ43O-z_tvwJoADvjwAWLx48JpOtx8U_v7ht-uj_r3_1pN0GP_qS6BYPmP_9w-TaMPNt2YhlIbgsyyA0F78B-zKyrQ</recordid><startdate>20140801</startdate><enddate>20140801</enddate><creator>Giaccaglia, V., MD</creator><creator>Salvi, P.F., MD, PhD</creator><creator>Cunsolo, G.V., MD</creator><creator>Sparagna, A., MD</creator><creator>Antonelli, M.S., MD</creator><creator>Nigri, G., MD, PhD, FACS, FASCRS</creator><creator>Balducci, G., MD</creator><creator>Ziparo, V., MD</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>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20140801</creationdate><title>Procalcitonin, as an early biomarker of colorectal anastomotic leak, facilitates enhanced recovery after surgery</title><author>Giaccaglia, V., MD ; Salvi, P.F., MD, PhD ; Cunsolo, G.V., MD ; Sparagna, A., MD ; Antonelli, M.S., MD ; Nigri, G., MD, PhD, FACS, FASCRS ; Balducci, G., MD ; Ziparo, V., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c505t-cf92ffa814ba74e284aa1aff6dd61c96a2cf3e450d0f0ef6d7e5a4568ebf90963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Age</topic><topic>Aged</topic><topic>Anastomotic leak</topic><topic>Anastomotic Leak - diagnosis</topic><topic>Area Under Curve</topic><topic>Bacterial infections</topic><topic>Biomarkers</topic><topic>Biomarkers - blood</topic><topic>C-Reactive Protein - analysis</topic><topic>Calcitonin - blood</topic><topic>Calcitonin Gene-Related Peptide</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Colorectal surgery</topic><topic>Confidence intervals</topic><topic>Critical Care</topic><topic>Elective Surgical Procedures</topic><topic>Enhanced recovery after surgery</topic><topic>Female</topic><topic>Heart attacks</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Infections</topic><topic>Leukocyte Count</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Postoperative Period</topic><topic>Predictive Value of Tests</topic><topic>Procalcitonin</topic><topic>Protein Precursors - blood</topic><topic>Proteins</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Giaccaglia, V., MD</creatorcontrib><creatorcontrib>Salvi, P.F., MD, PhD</creatorcontrib><creatorcontrib>Cunsolo, G.V., MD</creatorcontrib><creatorcontrib>Sparagna, A., MD</creatorcontrib><creatorcontrib>Antonelli, M.S., MD</creatorcontrib><creatorcontrib>Nigri, G., MD, PhD, FACS, FASCRS</creatorcontrib><creatorcontrib>Balducci, G., MD</creatorcontrib><creatorcontrib>Ziparo, V., MD</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>Proquest Nursing & Allied Health Source</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</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>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</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>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</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>Journal of critical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Giaccaglia, V., MD</au><au>Salvi, P.F., MD, PhD</au><au>Cunsolo, G.V., MD</au><au>Sparagna, A., MD</au><au>Antonelli, M.S., MD</au><au>Nigri, G., MD, PhD, FACS, FASCRS</au><au>Balducci, G., MD</au><au>Ziparo, V., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Procalcitonin, as an early biomarker of colorectal anastomotic leak, facilitates enhanced recovery after surgery</atitle><jtitle>Journal of critical care</jtitle><addtitle>J Crit Care</addtitle><date>2014-08-01</date><risdate>2014</risdate><volume>29</volume><issue>4</issue><spage>528</spage><epage>532</epage><pages>528-532</pages><issn>0883-9441</issn><eissn>1557-8615</eissn><abstract>Abstract Purpose 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. Methods 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. Results 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). Conclusions 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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24798346</pmid><doi>10.1016/j.jcrc.2014.03.036</doi><tpages>5</tpages></addata></record> |
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| subjects | Age Aged Anastomotic leak Anastomotic Leak - diagnosis Area Under Curve Bacterial infections Biomarkers Biomarkers - blood C-Reactive Protein - analysis Calcitonin - blood Calcitonin Gene-Related Peptide Chronic obstructive pulmonary disease Colorectal surgery Confidence intervals Critical Care Elective Surgical Procedures Enhanced recovery after surgery Female Heart attacks Hospitals Humans Infections Leukocyte Count Male Medical imaging Postoperative Period Predictive Value of Tests Procalcitonin Protein Precursors - blood Proteins Surgery |
| title | Procalcitonin, as an early biomarker of colorectal anastomotic leak, facilitates enhanced recovery after surgery |
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