Procalcitonin ratio and on-demand relaparotomy for septic peritonitis: validation of the focus index (FI)
Purpose Secondary peritonitis remains challenging to manage and some recent evidence suggests that on-demand relaparotomy is more appropriate than planned relaparotomy. This study was designed to validate the predictive power of postoperative procalcitonin (PCT) changes in relation to elimination of...
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| Veröffentlicht in: | Surgery today (Tokyo, Japan) Japan), 2016-05, Vol.46 (5), p.603-612 |
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| container_title | Surgery today (Tokyo, Japan) |
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| creator | Assfalg, Volker Wolf, Petra Reim, Daniel Hüser, Norbert Hellbrügge, Georg Matevossian, Edouard Friess, Helmut Holzmann, Bernhard Emmanuel, Klaus L. Novotny, Alexander R. |
| description | Purpose
Secondary peritonitis remains challenging to manage and some recent evidence suggests that on-demand relaparotomy is more appropriate than planned relaparotomy. This study was designed to validate the predictive power of postoperative procalcitonin (PCT) changes in relation to elimination of the septic abdominal focus.
Methods
In this prospective trial, postoperative PCT serum levels were monitored in 234 surgical patients with secondary peritonitis. The PCT ratio on postoperative days (PODs) 1 and 2 (focus index; FI) was calculated and correlated with the success of the operation.
Results
A cutoff value of 1.1 was calculated for the FI. Values below 1.1 indicated insufficient elimination of the focus and values above 1.1 correlated with effective treatment. The optimal time for first PCT sampling was found to be 12–24 h after the index operation. After the respective data cleanup, successful elimination of the intraabdominal focus could be confirmed, with a sensitivity of 93 % and a specificity of 71 %.
Conclusions
The FI is a single parameter-based reliable predictor of successful surgical eradication and strengthens the on-demand relaparotomy concept as the method of choice to treat secondary peritonitis. |
| doi_str_mv | 10.1007/s00595-015-1226-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1777075433</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1777075433</sourcerecordid><originalsourceid>FETCH-LOGICAL-c368t-5846ff05b4e8a8dad9901eb58b38770492a7ba24b62f665f3f5e7157e5becc23</originalsourceid><addsrcrecordid>eNp9kMtOwzAQRS0EouXxAWyQl2URsJ04D3aoooCEBAv2luOMwVViBztBlK_HoYUlqxlpzr3SHITOKLmkhBRXgRBe8YRQnlDG8uRrD81pluYJK2m6j-akymi8VHSGjkJYE8KykpBDNGM5iwHK58g8e6dkq8zgrLHYy8E4LG2DnU0a6KbNQyt76d3gug3WzuMA_WAU7sH_pAYTrvGHbE0zhS12Gg9vEEk1BmxsA594sXq4OEEHWrYBTnfzGL2sbl-W98nj093D8uYxUWleDgkvs1xrwusMSlk2sqkqQqHmZZ2WRUGyismiliyrc6bznOtUcygoL4DXoBRLj9FiW9t79z5CGERngoK2lRbcGAQtYkvBszSNKN2iyrsQPGjRe9NJvxGUiEmw2AoWUbCYBIuvmDnf1Y91B81f4tdoBNgWCPFkX8GLtRu9jR__0_oNve2HfA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1777075433</pqid></control><display><type>article</type><title>Procalcitonin ratio and on-demand relaparotomy for septic peritonitis: validation of the focus index (FI)</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Assfalg, Volker ; Wolf, Petra ; Reim, Daniel ; Hüser, Norbert ; Hellbrügge, Georg ; Matevossian, Edouard ; Friess, Helmut ; Holzmann, Bernhard ; Emmanuel, Klaus L. ; Novotny, Alexander R.</creator><creatorcontrib>Assfalg, Volker ; Wolf, Petra ; Reim, Daniel ; Hüser, Norbert ; Hellbrügge, Georg ; Matevossian, Edouard ; Friess, Helmut ; Holzmann, Bernhard ; Emmanuel, Klaus L. ; Novotny, Alexander R.</creatorcontrib><description>Purpose
Secondary peritonitis remains challenging to manage and some recent evidence suggests that on-demand relaparotomy is more appropriate than planned relaparotomy. This study was designed to validate the predictive power of postoperative procalcitonin (PCT) changes in relation to elimination of the septic abdominal focus.
Methods
In this prospective trial, postoperative PCT serum levels were monitored in 234 surgical patients with secondary peritonitis. The PCT ratio on postoperative days (PODs) 1 and 2 (focus index; FI) was calculated and correlated with the success of the operation.
Results
A cutoff value of 1.1 was calculated for the FI. Values below 1.1 indicated insufficient elimination of the focus and values above 1.1 correlated with effective treatment. The optimal time for first PCT sampling was found to be 12–24 h after the index operation. After the respective data cleanup, successful elimination of the intraabdominal focus could be confirmed, with a sensitivity of 93 % and a specificity of 71 %.
Conclusions
The FI is a single parameter-based reliable predictor of successful surgical eradication and strengthens the on-demand relaparotomy concept as the method of choice to treat secondary peritonitis.</description><identifier>ISSN: 0941-1291</identifier><identifier>EISSN: 1436-2813</identifier><identifier>DOI: 10.1007/s00595-015-1226-z</identifier><identifier>PMID: 26212215</identifier><language>eng</language><publisher>Tokyo: Springer Japan</publisher><subject>Aged ; Aged, 80 and over ; Biomarkers - blood ; Calcitonin - blood ; Humans ; Laparotomy - methods ; Medicine ; Medicine & Public Health ; Middle Aged ; Monitoring, Physiologic ; Original Article ; Peritonitis - diagnosis ; Peritonitis - surgery ; Postoperative Period ; Prospective Studies ; Reoperation ; Surgery ; Surgical Oncology</subject><ispartof>Surgery today (Tokyo, Japan), 2016-05, Vol.46 (5), p.603-612</ispartof><rights>Springer Japan 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c368t-5846ff05b4e8a8dad9901eb58b38770492a7ba24b62f665f3f5e7157e5becc23</citedby><cites>FETCH-LOGICAL-c368t-5846ff05b4e8a8dad9901eb58b38770492a7ba24b62f665f3f5e7157e5becc23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00595-015-1226-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00595-015-1226-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26212215$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Assfalg, Volker</creatorcontrib><creatorcontrib>Wolf, Petra</creatorcontrib><creatorcontrib>Reim, Daniel</creatorcontrib><creatorcontrib>Hüser, Norbert</creatorcontrib><creatorcontrib>Hellbrügge, Georg</creatorcontrib><creatorcontrib>Matevossian, Edouard</creatorcontrib><creatorcontrib>Friess, Helmut</creatorcontrib><creatorcontrib>Holzmann, Bernhard</creatorcontrib><creatorcontrib>Emmanuel, Klaus L.</creatorcontrib><creatorcontrib>Novotny, Alexander R.</creatorcontrib><title>Procalcitonin ratio and on-demand relaparotomy for septic peritonitis: validation of the focus index (FI)</title><title>Surgery today (Tokyo, Japan)</title><addtitle>Surg Today</addtitle><addtitle>Surg Today</addtitle><description>Purpose
Secondary peritonitis remains challenging to manage and some recent evidence suggests that on-demand relaparotomy is more appropriate than planned relaparotomy. This study was designed to validate the predictive power of postoperative procalcitonin (PCT) changes in relation to elimination of the septic abdominal focus.
Methods
In this prospective trial, postoperative PCT serum levels were monitored in 234 surgical patients with secondary peritonitis. The PCT ratio on postoperative days (PODs) 1 and 2 (focus index; FI) was calculated and correlated with the success of the operation.
Results
A cutoff value of 1.1 was calculated for the FI. Values below 1.1 indicated insufficient elimination of the focus and values above 1.1 correlated with effective treatment. The optimal time for first PCT sampling was found to be 12–24 h after the index operation. After the respective data cleanup, successful elimination of the intraabdominal focus could be confirmed, with a sensitivity of 93 % and a specificity of 71 %.
Conclusions
The FI is a single parameter-based reliable predictor of successful surgical eradication and strengthens the on-demand relaparotomy concept as the method of choice to treat secondary peritonitis.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biomarkers - blood</subject><subject>Calcitonin - blood</subject><subject>Humans</subject><subject>Laparotomy - methods</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Monitoring, Physiologic</subject><subject>Original Article</subject><subject>Peritonitis - diagnosis</subject><subject>Peritonitis - surgery</subject><subject>Postoperative Period</subject><subject>Prospective Studies</subject><subject>Reoperation</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><issn>0941-1291</issn><issn>1436-2813</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMtOwzAQRS0EouXxAWyQl2URsJ04D3aoooCEBAv2luOMwVViBztBlK_HoYUlqxlpzr3SHITOKLmkhBRXgRBe8YRQnlDG8uRrD81pluYJK2m6j-akymi8VHSGjkJYE8KykpBDNGM5iwHK58g8e6dkq8zgrLHYy8E4LG2DnU0a6KbNQyt76d3gug3WzuMA_WAU7sH_pAYTrvGHbE0zhS12Gg9vEEk1BmxsA594sXq4OEEHWrYBTnfzGL2sbl-W98nj093D8uYxUWleDgkvs1xrwusMSlk2sqkqQqHmZZ2WRUGyismiliyrc6bznOtUcygoL4DXoBRLj9FiW9t79z5CGERngoK2lRbcGAQtYkvBszSNKN2iyrsQPGjRe9NJvxGUiEmw2AoWUbCYBIuvmDnf1Y91B81f4tdoBNgWCPFkX8GLtRu9jR__0_oNve2HfA</recordid><startdate>20160501</startdate><enddate>20160501</enddate><creator>Assfalg, Volker</creator><creator>Wolf, Petra</creator><creator>Reim, Daniel</creator><creator>Hüser, Norbert</creator><creator>Hellbrügge, Georg</creator><creator>Matevossian, Edouard</creator><creator>Friess, Helmut</creator><creator>Holzmann, Bernhard</creator><creator>Emmanuel, Klaus L.</creator><creator>Novotny, Alexander R.</creator><general>Springer Japan</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>7X8</scope></search><sort><creationdate>20160501</creationdate><title>Procalcitonin ratio and on-demand relaparotomy for septic peritonitis: validation of the focus index (FI)</title><author>Assfalg, Volker ; Wolf, Petra ; Reim, Daniel ; Hüser, Norbert ; Hellbrügge, Georg ; Matevossian, Edouard ; Friess, Helmut ; Holzmann, Bernhard ; Emmanuel, Klaus L. ; Novotny, Alexander R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c368t-5846ff05b4e8a8dad9901eb58b38770492a7ba24b62f665f3f5e7157e5becc23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biomarkers - blood</topic><topic>Calcitonin - blood</topic><topic>Humans</topic><topic>Laparotomy - methods</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Monitoring, Physiologic</topic><topic>Original Article</topic><topic>Peritonitis - diagnosis</topic><topic>Peritonitis - surgery</topic><topic>Postoperative Period</topic><topic>Prospective Studies</topic><topic>Reoperation</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Assfalg, Volker</creatorcontrib><creatorcontrib>Wolf, Petra</creatorcontrib><creatorcontrib>Reim, Daniel</creatorcontrib><creatorcontrib>Hüser, Norbert</creatorcontrib><creatorcontrib>Hellbrügge, Georg</creatorcontrib><creatorcontrib>Matevossian, Edouard</creatorcontrib><creatorcontrib>Friess, Helmut</creatorcontrib><creatorcontrib>Holzmann, Bernhard</creatorcontrib><creatorcontrib>Emmanuel, Klaus L.</creatorcontrib><creatorcontrib>Novotny, Alexander R.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgery today (Tokyo, Japan)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Assfalg, Volker</au><au>Wolf, Petra</au><au>Reim, Daniel</au><au>Hüser, Norbert</au><au>Hellbrügge, Georg</au><au>Matevossian, Edouard</au><au>Friess, Helmut</au><au>Holzmann, Bernhard</au><au>Emmanuel, Klaus L.</au><au>Novotny, Alexander R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Procalcitonin ratio and on-demand relaparotomy for septic peritonitis: validation of the focus index (FI)</atitle><jtitle>Surgery today (Tokyo, Japan)</jtitle><stitle>Surg Today</stitle><addtitle>Surg Today</addtitle><date>2016-05-01</date><risdate>2016</risdate><volume>46</volume><issue>5</issue><spage>603</spage><epage>612</epage><pages>603-612</pages><issn>0941-1291</issn><eissn>1436-2813</eissn><abstract>Purpose
Secondary peritonitis remains challenging to manage and some recent evidence suggests that on-demand relaparotomy is more appropriate than planned relaparotomy. This study was designed to validate the predictive power of postoperative procalcitonin (PCT) changes in relation to elimination of the septic abdominal focus.
Methods
In this prospective trial, postoperative PCT serum levels were monitored in 234 surgical patients with secondary peritonitis. The PCT ratio on postoperative days (PODs) 1 and 2 (focus index; FI) was calculated and correlated with the success of the operation.
Results
A cutoff value of 1.1 was calculated for the FI. Values below 1.1 indicated insufficient elimination of the focus and values above 1.1 correlated with effective treatment. The optimal time for first PCT sampling was found to be 12–24 h after the index operation. After the respective data cleanup, successful elimination of the intraabdominal focus could be confirmed, with a sensitivity of 93 % and a specificity of 71 %.
Conclusions
The FI is a single parameter-based reliable predictor of successful surgical eradication and strengthens the on-demand relaparotomy concept as the method of choice to treat secondary peritonitis.</abstract><cop>Tokyo</cop><pub>Springer Japan</pub><pmid>26212215</pmid><doi>10.1007/s00595-015-1226-z</doi><tpages>10</tpages></addata></record> |
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| ispartof | Surgery today (Tokyo, Japan), 2016-05, Vol.46 (5), p.603-612 |
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| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Aged Aged, 80 and over Biomarkers - blood Calcitonin - blood Humans Laparotomy - methods Medicine Medicine & Public Health Middle Aged Monitoring, Physiologic Original Article Peritonitis - diagnosis Peritonitis - surgery Postoperative Period Prospective Studies Reoperation Surgery Surgical Oncology |
| title | Procalcitonin ratio and on-demand relaparotomy for septic peritonitis: validation of the focus index (FI) |
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