Procalcitonin Monitoring Helps Assess Sepsis, Prognosis in Surgical ICU (printer-friendly)

6/2/15, 2:12 PM

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CME Information
CME Released: 02/23/2007 ; Valid for credit through 02/23/2008
This activity has expired.
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Learning Objectives
Upon completion of this activity, participants will be able to:
Compare the usefulness of procalcitonin vs CRP for predicting MODS with and without sepsis and mortality
after surgery.
Define the best cut-off point and interval since surgery for procalcitonin to predict outcomes in postoperative
patients with peritonitis.

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Procalcitonin Monitoring Helps Assess Sepsis, Prognosis in Surgical ICU (printer-friendly)

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Procalcitonin Monitoring Helps Assess Sepsis, Prognosis in Surgical ICU (printer-friendly)

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Author(s)
Laurie Barclay, MD

Laurie Barclay is a freelance reviewer and writer for Medscape.

Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

CME Author(s)
Dsire Lie, MD, MSEd

Clinical Professor, Family Medicine, University of California, Orange; Director, Division of Faculty Development, UCI
Medical Center, Orange, California
Disclosure: Dsire Lie, MD, MSEd, has disclosed no relevant financial relationships.

From Medscape Medical News

Procalcitonin Monitoring Helps Assess Sepsis, Prognosis in

Surgical ICU
News Author: Laurie Barclay, MD
CME Author: Dsire Lie, MD, MSEd
CME Released: 02/23/2007 ; Valid for credit through 02/23/2008

February 23, 2007 Procalcitonin monitoring is a fast and reliable diagnostic approach to assess septic complications
and overall prognosis in patients with secondary intra-abdominal infections in the surgical intensive care unit (ICU),
according to the results of a prospective, international, multicenter inception cohort study reported in the February
issue of the Archives of Surgery.
"Infections and sepsis are major complications in secondary peritonitis and still represent a diagnostic challenge," write
Bettina M. Rau, MD, of the University of the Saarland in Homburg/Saar, Germany, and colleagues. "There is major
interest in the search for an optimum diagnostic tool for an early, noninvasive, and reliable diagnosis of abdominal
infections and sepsis.... We hypothesized that the laboratory marker procalcitonin would provide an early and reliable
assessment of septic complications."
At 5 European surgical referral centers, 82 patients with intraoperatively proven secondary peritonitis were enrolled
within 96 hours of symptom onset. Procalcitonin and the routine laboratory marker C-reactive protein (CRP) were
prospectively evaluated and monitored for up to 21 consecutive days.
Peak procalcitonin levels occurring early after symptom onset or during the immediate postoperative course, but not
CRP levels, were closely correlated with the development of septic multiorgan dysfunction syndrome (MODS).
Receiver-operating characteristic analysis revealed that a procalcitonin value of 10.0 ng/mL or more on 2 consecutive
days was superior to a CRP level of 210 mg/L or more for predicting septic MODS. Sensitivity, specificity, and positive
and negative predictive values were 65%, 92%, 83%, and 81% for procalcitonin and 67%, 58%, 49%, and 74% for
CRP, respectively ( P < .001). Evaluation of septic MODS was already possible on the first 2 postoperative days, and
sensitivity and specificity were similar. Procalcitonin levels persistently higher than 1.0 ng/mL beyond the first week
after disease onset strongly indicated mortality and were superior to CRP in assessing overall prognosis ( P < .001).
"Procalcitonin monitoring is a fast and reliable approach to assessing septic MODS and overall prognosis in secondary
peritonitis," the authors write. "This single-test marker improves stratification of patients who will develop clinically

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relevant complications."
Limitations of procalcitonin monitoring include inability to substitute for a careful history and clinical examination, cutoff
levels for predicting septic complications or overall prognosis are disease dependent and vary considerably among
different inflammatory conditions, large procalcitonin ranges in the septic MODS group, and nonspecific indicator of
infection without provision of information about the source of infection.
"In terms of practicability, procalcitonin meets the demands of a readily available biochemical marker under clinical
routine and emergency conditions," the authors conclude. "[Procalcitonin] could further help improve clinical decision
making and allocation of patients for scientific trials."
Brahms Diagnostica AG supported this study and has financial relationships with Dr. Rau.
Arch Surg. 2007;142:134-142.

A 64-year-old man with secondary bacterial peritonitis has elevated procalcitonin levels and normal CRP
levels on day 2 after surgery. According to this study, elevated procalcitonin is likely to predict all of the
following outcomes except:
Mortality within 21 days
Septic MODS
MODS without sepsis
Cardiovascular death
According to this study, the cutoff point for an elevated procalcitonin level after the first week after the
onset of symptoms for predicting subsequent nonsurvival is best described by which of the following?
> 1 ng/mL
0.1 mg/mL
210 mg/mL
10 ng/mL
Save and Proceed

Medscape Medical News 2007

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