Use of procalcitonin for early prediction of lethal outcome of postoperative sepsis

Novotny, Alexander; Emmanuel, Klaus; Matevossian, Edouard; Kriner, Monika; Ulm, Kurt; Bartels, Holger; Holzmann, Bernhard; Weighardt, Heike; Siewert, Jörg-Rüdiger

doi:10.1016/j.amjsurg.2006.10.026

« Previous Next »The American Journal of Surgery
Volume 194, Issue 1 , Pages 35-39, July 2007

Use of procalcitonin for early prediction of lethal outcome of postoperative sepsis

Alexander Novotny, M.D.
- Department of Surgery, Klinikum rechts der Isar, Technische Universität, Ismaninger Str. 22, 81675 Munich, Germany
- Corresponding author. Tel.: +49-89-4140-2034; fax: +49-89-4140-6605.
Klaus Emmanuel, M.D.
- Department of Surgery, Klinikum rechts der Isar, Technische Universität, Ismaninger Str. 22, 81675 Munich, Germany
Edouard Matevossian, M.D.
- Department of Surgery, Klinikum rechts der Isar, Technische Universität, Ismaninger Str. 22, 81675 Munich, Germany
Monika Kriner, Ph.D.
- Institute of Medical Statistics and Epidemiology, Technische Universität, Trogerstr. 7, 81675 Munich, Germany
Kurt Ulm, Ph.D.
- Institute of Medical Statistics and Epidemiology, Technische Universität, Trogerstr. 7, 81675 Munich, Germany
Holger Bartels, M.D.
- Department of Surgery, Klinikum rechts der Isar, Technische Universität, Ismaninger Str. 22, 81675 Munich, Germany
Bernhard Holzmann, M.D.
- Department of Surgery, Klinikum rechts der Isar, Technische Universität, Ismaninger Str. 22, 81675 Munich, Germany
Heike Weighardt, Ph.D.
- Department of Surgery, Klinikum rechts der Isar, Technische Universität, Ismaninger Str. 22, 81675 Munich, Germany
- H.W. and J.-R.S contributed equally to this work.
Jörg-Rüdiger Siewert, M.D.
- Department of Surgery, Klinikum rechts der Isar, Technische Universität, Ismaninger Str. 22, 81675 Munich, Germany
- H.W. and J.-R.S contributed equally to this work.

Received 18 March 2006; received in revised form 4 October 2006 published online 17 May 2007.

Abstract

Background

To develop strategies for the prediction of sepsis outcome systemic procalcitonin (PCT) levels were correlated with various clinical parameters.

Methods

PCT levels and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were assessed on the day of sepsis diagnosis in a large series (n = 160) of patients developing sepsis after major visceral surgery.

Results

In multivariate analysis, systemic PCT and the APACHE II score could be identified as independent early predictive indicators of lethal sepsis. Combining both indicators at sepsis onset, a prognosis score could be calculated using binary logistic regression analysis allowing the identification of high- and low-risk groups. While 71% of the high-risk patients died of sepsis, 77% of patients assigned to the low-risk group survived the septic complication (sensitivity 71%, specificity 77%).

Conclusion

Calculation of the prognosis-score allowed for an early prediction of the septic course with high sensitivity and specificity. This information could aid in deciding on adequate treatment strategies.

Keywords: Procalcitonin, Sepsis, Peritonitis, APACHE II, Prognosis, Risk evaluation