6/2/15, 2:12 PMProcalcitonin Monitoring Helps Assess Sepsis, Prognosis in Surgical ICU (printer-friendly)

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CME Released: 02/23/2007 ; Valid for credit through 02/23/2008

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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 mortalityafter surgery.Define the best cut-off point and interval since surgery for procalcitonin to predict outcomes in postoperativepatients with peritonitis.

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6/2/15, 2:12 PMProcalcitonin 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)Désirée Lie, MD, MSEd

Clinical Professor, Family Medicine, University of California, Orange; Director, Division of Faculty Development, UCIMedical Center, Orange, California

Disclosure: Désirée Lie, MD, MSEd, has disclosed no relevant financial relationships.

From Medscape Medical News

News Author: Laurie Barclay, MDCME Author: Désirée Lie, MD, MSEd

February 23, 2007 — Procalcitonin monitoring is a fast and reliable diagnostic approach to assess septic complicationsand 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 Februaryissue of the Archives of Surgery.

"Infections and sepsis are major complications in secondary peritonitis and still represent a diagnostic challenge," writeBettina M. Rau, MD, of the University of the Saarland in Homburg/Saar, Germany, and colleagues. "There is majorinterest in the search for an optimum diagnostic tool for an early, noninvasive, and reliable diagnosis of abdominalinfections and sepsis.... We hypothesized that the laboratory marker procalcitonin would provide an early and reliableassessment of septic complications."

At 5 European surgical referral centers, 82 patients with intraoperatively proven secondary peritonitis were enrolledwithin 96 hours of symptom onset. Procalcitonin and the routine laboratory marker C-reactive protein (CRP) wereprospectively evaluated and monitored for up to 21 consecutive days.

Peak procalcitonin levels occurring early after symptom onset or during the immediate postoperative course, but notCRP 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 consecutivedays was superior to a CRP level of 210 mg/L or more for predicting septic MODS. Sensitivity, specificity, and positiveand negative predictive values were 65%, 92%, 83%, and 81% for procalcitonin and 67%, 58%, 49%, and 74% forCRP, respectively ( P < .001). Evaluation of septic MODS was already possible on the first 2 postoperative days, andsensitivity and specificity were similar. Procalcitonin levels persistently higher than 1.0 ng/mL beyond the first weekafter 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 secondaryperitonitis," the authors write. "This single-test marker improves stratification of patients who will develop clinically

Procalcitonin Monitoring Helps Assess Sepsis, Prognosis inSurgical ICU

CME Released: 02/23/2007 ; Valid for credit through 02/23/2008

6/2/15, 2:12 PMProcalcitonin Monitoring Helps Assess Sepsis, Prognosis in Surgical ICU (printer-friendly)

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relevant complications."

Limitations of procalcitonin monitoring include inability to substitute for a careful history and clinical examination, cutofflevels for predicting septic complications or overall prognosis are disease dependent and vary considerably amongdifferent inflammatory conditions, large procalcitonin ranges in the septic MODS group, and nonspecific indicator ofinfection without provision of information about the source of infection.

"In terms of practicability, procalcitonin meets the demands of a readily available biochemical marker under clinicalroutine and emergency conditions," the authors conclude. "[Procalcitonin] could further help improve clinical decisionmaking 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 CRPlevels on day 2 after surgery. According to this study, elevated procalcitonin is likely to predict all of thefollowing outcomes except:

Mortality within 21 daysSeptic MODSMODS without sepsisCardiovascular death

According to this study, the cutoff point for an elevated procalcitonin level after the first week after theonset of symptoms for predicting subsequent nonsurvival is best described by which of the following?

> 1 ng/mL0.1 mg/mL210 mg/mL10 ng/mL

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Medscape Medical News © 2007 The material presented here does not necessarily reflect the views of Medscape or companies that supporteducational programming on www.medscape.com. These materials may discuss therapeutic products that have notbeen approved by the US Food and Drug Administration and off-label uses of approved products. A qualifiedhealthcare professional should be consulted before using any therapeutic product discussed. Readers should verify allinformation and data before treating patients or employing any therapies described in this educational activity.