Blood Marker Helps Predict Prognosis

Bettina M. Rau, M.D., University of the Saarland, Homber/Saar, Germany, and colleagues enrolled 82 patients with secondary peritonitis between 1999 and 2004 within the study. Procalcitonin, an inactive precursor to a hormone known as calcitonin, has been shown to be more prevalent in patients with bacterial and fungal infections and sepsis. Bacterial specimens were obtained from the abdomens of all participants, as were other tissue cultures when sepsis was suspected. The patients were monitored from within 96 hours of their first symptoms to a maximum of 21 days for levels of procalcitonin and another marker of inflammation, C-reactive protein, and for signs of lung or kidney failure.

Over the follow-up period, 42 patients developed lung failure, 25 developed kidney failure, 35 had multiorgan dysfunction syndrome and nine died. “Procalcitonin concentrations were most closely correlated with the development of septic multi-organ dysfunction syndrome, with peak levels occurring early after symptom onset or during the immediate post-operative course,” the authors write. “No such correlation was observed for C-reactive protein.”

It was possible to predict multi-organ dysfunction syndrome by assessing procalcitonin levels on the first two days following surgery; those with values of ten nanograms per milliliter on two consecutive days were at higher risk. “Persisting procalcitonin levels greater than one nanogram per milliliter beyond the first week after disease onset strongly indicated non-survival and were significantly better than C-reactive protein in assessing overall prognosis,” they continue.

In summary, monitoring of procalcitonin levels seems to be a fast and reliable approach to assessing severe septic complications and overall prognosis in patients with secondary peritonitis, the authors conclude.; Source: American Medical Association (AMA)