OriginalProcalcitonina y proteína C reactiva como marcadores precoces de infección intraabdominal postoperatoria en pacientes operados de cáncer gastrointestinalProcalcitonin and C-reactive protein as early indicators of postoperative intra-abdominal infection after surgery for gastrointestinal cancer
Section snippets
Introducción
Ocasionalmente, la infección intraabdominal postoperatoria (IIAP) se presenta como un cuadro de abdomen agudo y resulta fácil de diagnosticar. Sin embargo, la mayor parte de las veces se manifiesta con una sintomatología larvada e inespecífica y la exploración abdominal puede ser equívoca. Además, las pruebas de laboratorio habitualmente utilizadas durante el postoperatorio, como el recuento leucocitario, son poco sensibles y específicas. Todo ello conduce a que la IIAP se suela diagnosticar
Pacientes y métodos
Se llevó a cabo un estudio observacional prospectivo en el que se incluyó a 67 pacientes operados de cáncer colorrectal, páncreas o estómago, de forma consecutiva, entre el 1 de enero y el 30 de junio de 2011 en el Servicio de Cirugía del Complejo Hospitalario de Pontevedra (CHOP) Los criterios de exclusión fueron la edad inferior a 18 años, la cirugía de urgencia o paliativa, la existencia de infección preoperatoria y niveles preoperatorios de PCT superiores a 0,5 ng/ml. Ninguno de los
Resultados
En el periodo de tiempo objeto del estudio se operó a otros 8 pacientes que fueron excluidos por no estar completos los valores de PCR o PCT (3 casos), por valor preoperatorio de PCT superior a 0,5 ng/ml (3 casos), por cirugía paliativa (un caso) o por rechazo a participar en el estudio (un caso). Cuarenta pacientes (59,7%) eran varones y 27 (40,3%) eran mujeres, con una edad media de 69 años y una mediana de 68 (rango 42-89). En la tabla 1 se resumen los datos correspondientes a tipo de tumor,
Discusión
Este estudio muestra que la cirugía del cáncer gastrointestinal induce una elevación de los niveles séricos de PCR y PCT en prácticamente todos los pacientes y que la máxima concentración se alcanza antes para la PCT que para la PCR. Ambas proteínas son marcadores útiles para la predicción de la infección intraabdominal postoperatoria, con un valor predictivo negativo (VPN) muy alto, ya en los 3 primeros días de postoperatorio, aunque el valor predictivo positivo (VPP) es bajo. Considerando
Financiación
Parcialmente con una beca de la Fundación José Luis Castaño.
Conflicto de intereses
No hay conflictos de intereses.
Bibliografía (31)
- et al.
The failed gastrointestinal anastomosis: An inevitable catastrophe?
J Am Coll Surg
(1999) - et al.
Procalcitonin, interleukin 6 and systemic inflammatory reponse syndrome (SIRS): Early markers of postoperative sepsis after major surgery
Br J Anaesth
(2005) - et al.
Pneumoitis-associated hyperprocalcitoninemia
Am J Med Sci
(1996) - et al.
Evolution and significance of circulating procalcitonin levels compared with Il-6, TNF[alpha], and endotoxin levels early after thermal injury
Burns
(1997) - et al.
Inflammatory cytokines, C reactive protein and procalcitonin as early predictors of necrosis infection in acute necrotizinf pancreatitis
Surgery
(2003) - et al.
CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting
Am J Infect Control
(2008) - et al.
C-reactive protein is an early predictor of septic complications after elective colorectal surgery
World J Surg
(2010) - et al.
Diagnostic accuracy of C-reactive protein and white blood cell counts in the early detection of inflammatory complications after open resection of colorectal cancer: A retrospective study of 1,187 patients
Int J Colorectal Dis
(2011) - et al.
Procalcitonin in early detection of postoperative complications
Dig Surg
(1998) - et al.
Serum procalcitonin in the diagnosis and management of intra-abdominal infections
Expert Rev Anti Infect Ther
(2012)
C-reactive protein as early predictor for infectious potoperative complications in rectal surgery
Int J Colorectal Dis
Increasesed serum levels of C-reactive protein precede anastomotic leakage in colorectal surgery
Worl J Surg
Predicting severity of acute pancreatitis
Curr Gastroenterol Rep
Relationship between procalcitonin plasma levels and severity of injury, sepsis, organ failure, and mortality in injured patients
Crit Care Med
Procalcitonin assay in systemic inflammation, infection and sepsis: Clinical utility and limitations
Crit Care Med
Cited by (19)
Procalcitonin as an Early Predictor of Intra-abdominal Infections Following Gastric Cancer Resection
2021, Journal of Surgical ResearchCitation Excerpt :To the best of our knowledge, little is known about the usefulness of the PCT to predict IAIs after gastrectomy. Presently, there are only three studies that reported the value of PCT to predict postoperative infections regarding GC.26-28 The number of patients enrolled in Montagnana’s and Dominguez-Comesana’s studies were very small (18 and 67, respectively), and they both examined the predictive value of PCT for postoperative infection after gastrointestinal cancer rather than GC specifically.
C-reactive protein, procalcitonin and interleukin-6 kinetics in pediatric postoperative patients
2017, Journal of Critical CareCitation Excerpt :There are studies that support PCT usefulness as prognostic marker and diagnostic tool for infection diagnosis during this period [8-19]. Nevertheless, there are other studies that conclude that CRP [20-23] or IL-6 [18,21,24,25] are valid or better for this purpose than PCT. However, the majority of those studies were conducted in children or adults after cardiac surgery and cardiopulmonary bypass [8-10,12,25].
Simplified acute physiology score II and Mannheim peritonitis index are associated with in-hospital mortality in patients with abdominal sepsis admitted to ICU
2022, Cirugia y Cirujanos (English Edition)Procalcitonin and C-Reactive Protein as an Early Predictor of Infection in Elective Gastrointestinal Cancer Surgery—a Prospective Observational Study
2022, Journal of Gastrointestinal CancerEarly Diagnosis of Anastomotic Leakage After Gastric Cancer Surgery Via Analysis of Inflammatory Factors in Abdominal Drainage
2022, Annals of Surgical OncologyDiagnostic challenges in postoperative intra-abdominal sepsis in critically ill patients: When to reoperate?
2022, Postepy Higieny i Medycyny Doswiadczalnej