Procalcitonin as an Early Predictor of Septic Complications after Elective Colon Surgery: A Comparative Study versus Interleukin-6 and C-reactive Protein
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This study aimed to assess the utility of estimation of plasma Procalcitonin (PCT) and serum interleukin-6 (7L-6) and C-reactive protein (CRP), as early (within 24 h after surgery) predictors of postoperative septic complications in patients who underwent elective colonic resection for malignant disease. The study included 40 patients and 10 healthy subjects as controls for the preoperative values. Patients were observed at ICU for their first 5 postoperative days for the development of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis or septic shock that were defined according to Bone's criteria. Patients were allocated into 3 groups on the basis of signs of sepsis: Group A (No SIRS/Sepsis), Group B (SIRS) and Group C (Sepsis) group. Blood samples were obtained the day before surgery (Day-0) and at the morning of the first postoperative day (Day-I) for estimation of serum CRP and IL-6 and plasma PCT. Eight patients developed SIRS and 9 patients progressed to sepsis with a total morbidity rate of 42.5%. One patient developed septic shock and died with a mortality rate of 2.5%. Day-0 serum CRP and plasma PCT showed nonsignificant difference, while Day-0 serum IL-6 was significantly higher compared to control levels. However, Day-1 levels of the three parameters were significantly higher compared to their Day-0 levels. Day-1 serum levels of CRP showed nonsignificant difference between the three study groups; however, Day- I serum IL-6 was non-signcantly higher in group B but was significantly higher in group C compared to its levels in group A with a non-significant increase in group C compared to group B . Day-I plasma levels of PCT were significantly higher in groups B and C compared to its levels in group A with a significant increase in group C compared to group B. There was a positive significant correlation between the frequency of occurrence of SIRS and/or septic complication with levels of serum IL-6 and of plasma PCT, while the correlation was positive non-significant with serum CRP levels and ROC curve analysis showed that plasma PCT levels were highly specific (AUC=0.928), followed by serum levels of IL-6 (AUC=0.763) and serum CRP was the least specific parameter (AUC=0.498). It could be concluded that PCT can be used as a reliable diagnostic parameter to detect and to monitor infectiffs complications in the postoperative period after colonic surgery and can be detected before the occurrence of clinical infection, especially in patients suspected to be at higher risk for development of SIRS or septic complications.