Value Of Plasma Procalcitonin (PCT) Estimation As A Marker For Postoperative Sepsis In Elective Colonic Resections
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Objectives : This study aimed to assess the utility of estimation of plasma Procalcitonin (PCT) and serum interleukin-6 (IL-6) and C-reactive protein (CRP), as an early (within 24 h after surgery) predictors of postoperative septic complications in patients underwent elective colonic resection for malignant disease. Patients & Methods: The study included 40 patients and 10 healthy subjects as controls for the preoperative values. Patients were observed at surgical intensive care unite for their first 5 postoperative days for the development of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis or septic shock that 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 on the morning of the first postoperative day (Day-1) for estimation of serum CRP and IL- 6 and plasma PCT. Results : All patients passed smooth intraoperative course with no intraoperative complications and all lesions were operable and resectable with a mean duration of surgery of 221.3±20.3 minutes and a mean blood loss of 65013501c. Blood transfusion was required for 17 patients (42.5%) with a mean number of transfused bags of 2.6-11.1 units. Oral feeding was resumed after a mean period of 4.5±1.3 days with a mean postoperative hospital stay was 10.9±4 days. Eight patients developed SIRS and 9 patients progressed to sepsis with a total morbidity rate of 42.5%. Out of these patients, 2 patients had localized peritonitis and one of them had anastomotic line dehiscence with a technical success rate of 95% and 6 patients had wound complications with a surgical success rate of 85%. One patient developed septic shock and died with a mortality rate of 2.5%. Day-0 serum CRP and plasma PCT showed non-significant 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 non-significant difference between the three study groups; however, Day-1 serum IL-6 was non-significantly 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-1 plasma levels of Pa 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 PC7', while the correlation was positive non-significant with serum CRP levels and the receiver operating characteristic curve (ROC) analysis showed that plasma PCT levels were highly specific (area under the curve, AUC=0.928), followed by serum levels of IL-6 (AUC=0.763) and serum CRP was the least specific parameter (AUC=0.498). Conclusion : It could be concluded that PCT can be used as a reliable diagnostic parameter to detect and to monitor infectious complications in the postoperative period after colonic surgery and can be detected before the occurrence of clinical infection, especially in patients felt to be at higher risk for development of SIRS or septic complications.