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

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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