Procalcitonin and C-reactive Protein Measurements in the Early Diagnosis of Surgical Site Infections After Cesarean Section

Abstract

Objective: We aimed to determine whether serum procalcitonin (PCT) levels measured after cesarean section were superior to the levels of other infection markers in the early diagnosis of surgical site infection (SSI). Material and Methods: The present study was conducted with consecutive 249 patients who underwent elective primary cesarean delivery in our obstetrics clinic of a Private Hospital between November 2018 and April 2019. Measurements of serum PCT, C-reactive protein (CRP) and white blood cell (WBC) counts were performed at the postoperative 6th, 12thand 24th hours. The participating patients were examined for SSI on the postoperative 2nd,4h and 7th days. Results: Of the participants, 15 (6%) developed surgical site infections, PCT was the most sensitive and specific marker of the SSI. Area under the curve (AUC) for PCT in predicting the SSI was 0.912 (95% CI: 0.79-1) and cutoff point was 0.099 ng/ml with a sensitivity of 93.3%, and specificity of 92.3% (p<0.001). Area under the curve (AUC) for CRP in predicting the SSI was 0.854 (95% CI: 0.782 - 0.926) and cutoff point was 16.95 mg/dL with a sensitivity of 80%, and specificity of 82.4%. Area under the curve (AUC) for WBC in predicting the SSI was 0.819 (95% CI: 0.708-0.931) and cutoff point was 18.8 x 109/L with a sensitivity of 73.3%, and specificity of 83.0%. Conclusion: Serum PCT levels were found to be a more sensitive and specific marker in the early diagnosis of SSI after cesarean section than were the other conventional infection markers.

Keywords

• Prokalsitonin
• C-reaktif protein
• yara yeri enfeksiyonu
• sezaryen

Project Number

108400098-604.01.01-E.47627

Sezaryen Sonrası Cerrahi Alan Enfeksiyonlarının Erken Dönem Tanısında Prokalsitonin ve C-reactive protein Ölçümlerinin Yeri

Abstract

Giriş ve Amaç: Sezaryen sonrası ölçülen serum prokalsitonin (PKT) düzeylerinin cerrahi alan enfeksiyonu (CAE)'ların erken tanısında diğer enfeksiyon belirteçlerine gore üstün olup olmadığını belirlemeyi amaçladık. Gereç ve Yöntemler: Bu çalışma, Kasım 2018 ile Nisan 2019 tarihleri arasında Özel Hastane kadın doğum kliniğimizde elektif primer sezaryen ile doğum yapan 249 hasta üzerinde gerçekleştirildi. Postoperatif 6., 12. ve 24. saatlerde serum PKT, C-reaktif protein (CRP) ve beyaz kan hücresi sayılarının ölçümleri yapıldı. Hastalar postoperatif 2., 4. ve 7. günlerde CAE açısından incelendi. Bulgular: Katılımcıların 15'inde (%6) cerrahi alan enfeksiyonu gelişti. PKT, CAE'ların en hassas ve spesifik belirleyicisiydi. PKT için CAE'nın öngörülmesinde eğri altındaki alan 0.912 (% 95 CI: 0,79-1) ve kesme noktası 0,099 ng / ml , % 93,3 duyarlılık ve % 92,3 özgüllük idi (p <0.001). CAE tahmininde CRP eğri altındaki alan (EAA) 0.854 (% 95 CI: 0.782 - 0.926) ve kesme noktası 16.95 mg/dL, %80 hassasiyet ve % 82,4 özgüllük idi. CAE'yi öngörmede beyaz kan hücresi için eğri altındaki alan (AUC) 0.819 (% 95 CI: 0.708-0.931) ve kesme noktası 18.8x109 /L, % 73,3 hassasiyet ve % 83,0 özgüllük idi. Sonuç: Serum PKT düzeyleri, sezaryen sonrası CAE'ların erken tanısında diğer konvansiyonel enfeksiyon belirteçlerinden daha duyarlı ve özgün bir belirteç olarak bulundu.

Keywords

• Procalcitonin
• C-reaktive protein
• surgıcal site infection
• cesarean section

Supporting Institution

bulunmamaktadır

Project Number

108400098-604.01.01-E.47627

References

1. Niino, Y, The increasing cesarean rate globally and what we can do about it, BioScience Trends,2011, 5(4), 139-150.
2. Souza, J.P, Betran, A.P, Dumont, A, De Mucio, B, GibbsPickens, C.M, Deneux-tharaux, C, et al., A global reference for caesarean- sectionrates (C-Model): a multicountry cross-sectional study, BJOG:An International Journal of Obstetrics & Gynaecology,2016, 123(3), 427-36.
3. Zuarez-Easton, S, Zafran, N, Garmi, G, et al., Postcesarean wound infection: prevalence, impact, prevention, and management challenges, International Journal of Women's Health, 2017, 9, 81–88.
4. Olsen, M.A, Butler, A.M, Willers, D.M, et al., Attributable costs of surgical site infection and endometritis after low transverse cesarean delivery, Infection Control & Hospital Epidemiology, 2010, 31(3), 276–282.
5. Salim, R, Braverman, M, Teitler, N, Berkovic, I, Suliman, A, Shalev, E, Risk factors for infection following cesarean delivery: an interventional study, The Journal of Maternal-Fetal & Neonatal Medicine, 2012, 25(12), 2708–2712.
6. Russwurm, S, Wiederhold, M, Oberhoffer, M, Stonans, I, Zipfel, PF, Reinhart, K, Molecular aspects and natural source of procalcitonin, Clinical Chemistry and Laboratory Medicine,1999, 37(8), 789-797.
7. Nijsten, M, Olinga, P, The, T.H, de Vries, E.G, Koops, H.S, Groothuis, G.M, et al., Procalcitonin behaves as a fast responding acute phase protein in vivo and in vitro, Critical Care Medicine, 2000, 28(2), 458-461.
8. Giovanella, L, Serum procalcitonin and calcitonin normal values before and after calcium gluconate infusion, Experimental and Clinical Endocrinology & Diabetes Reports, 2012, 120(3), 169-170.

9. Wacker C, Prkno A, Brunkhorst FM, et al. Procalcitoninas a diagnostic marker for sepsis: a systematic review and meta-analysis. The Lancet Infectious Diseases,2013, 13(5), 426–435.
10. Dandona, P, Nix, D, Wilson, M.F, Aljada, A, Love, J, Assicot, M, et al. Procalcitonin increase after endotoxin injection in normal subjects, The Journal of Clinical Endocrinology & Metabolism, 1994,79(6), 1605|-1608.
11. Recipon, G, Piver, E, Caille, A, et al., Is procalcitonin increased in cases of invasive amoebiasis? A retrospective, observational study, Diagnostic Microbiology and Infectious Disease, 2015, 83(4), 395–399. 12.
12. Chengfen, Y, Tong, L, Xinjing, G, Zhibo, L, Lei, X, Accuracy of procalcitonin for diagnosis of sepsis in adults: a Meta-analysis. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 2015, 27(9), 743-749.
13. Linscheid, P, Seboek, D, Nylen, E.S, et al., In vitro and in vivo calcitonin I gene expression in parenchymal cells: a novel product of human adipose tissue, Endocrinology, 2003, 144(12), 5578–5584.
14. Potjo, M, Theron, A.J, Cockeran, R, Sipholi. N.N, Steel, H.C, Bale, T.V, Meyer, P.W.A, Anderson, R, Tintinger, G.R. Interleukin-10 and interleukin-1 receptor antagonist distinguish between patients with sepsis and the systemic inflammatory response syndrome (SIRS), Cytokine, 2019, 120, 227-233.
15. Caluianu EI et al., Utilizing Multiparameter Scores and Procalcitonin as Prognosis Markers for the Degree of Severity of Acute Pancreatitis, Current Health Sciences Journal, 2017, 43(4), 311-317.
16. Cossé, C, Sabbagh, C, Carroni, V, Galmiche, A, Rebibo, L, Regimbeau, J.M., Impact of a procalcitonin-based algorithm on the management of adhesion-related small bowel obstruction, Journal of Visceral Surgery, 2017, 154(4), 231-237.
17. Parli, S.E, Trivedi, G, Woodworth, A, Chang, P.K, Procalcitonin: Usefulness in Acute Care Surgery and Trauma, Surgical Infection (Larchmt),. 2018, 19(2), 131-136.
18. Whicher, J, Bienvenu, J, Monneret, G, Procalcitonin as an acute phase marker, Annals of Clinical Biochemistry, 2001, 38(5), 483-493.
19. Çetin, B.A, Mathyk, B.A, Koroglu, N, et al., Serum procalcitonin levels in incisional surgical site infections requiring a secondary suture after cesarean sections, The Journal of Maternal-Fetal & Neonatal Medicine, 2019, 32(24), 4108-4113.
20. Bond, M, Pilowsky, I. Subjective evaluation of its relationship with analgesic administration in pain and cancer patients. The Journal of Psychosomatic Research 1966, 10(2), 203-208.
21. Wang, T, Wang, H, Yang, D.L, Jiang, L.Q, Zhang, L.J, Ding, W.Y., Factors predicting surgical site infection after posterior lumbar surgery: A multicenter retrospective study, Medicine (Baltimore), 2017, 96(5), 6042.
22. Kara, S.S, Akbulut, A, Tartar, A.S, Akbulut, H.H, Demirdağ, K, Beştaş, A, Procalcitonin levels among patients with fever secondary to severe intracerebral infection, A cross-sectional study, Sao Paulo Medical Journal, 2019, 137(4), 349-355.
23. Oberhofer, D, Juras, J, Pavicic, A.M, et al., Comparison of Creactive protein and procalcitonin as predictors of postoperative infectious complications after elective colorectal surgery, Croatian Medical Journal, 2012, 53(6), 612–619.
24. Aljabi, Y, Manca, A, Ryan, J, Elshawarby, A, Value of procalcitonin as a marker of surgical site infection following spinal surgery, The Surgeon, 2019, 17(2), 97-101.
25. Takakura, Y, Hinoi, T, Egi, H, Shimomura, M, Adachi, T, et al., Procalcitonin as a predictive marker for surgical site infection in elective colorectal cancer surgery, Langenbecks Archives of Surgery, 2013, 398(6), 833–839.