Colorectal surgery: procalcitonin to detect postoperative intra-abdominal infection

  • Tan WJ & al.
  • Int J Colorectal Dis

  • Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Procalcitonin (PCT) may help detect and rule out intra-abdominal infection (IAI) after colorectal surgery.
  • Authors suggest that PCT 

Why this matters

  • Early diagnosis of IAI can be difficult.
  • An IAI biomarker could improve outcomes and boost Enhanced Recovery After Surgery (ERAS).
  • PCT is more infection-specific than C-reactive protein.
  • It is unclear how helpful PCT is in predicting IAI after colorectal surgery.

Study design

  • Systematic review, meta-analysis to May 2016, with anastomotic leakage included as an IAI subtype (8 articles; n=1629).
  • Participants were adults, post-elective colorectal anastomosis, with PCT drawn between PODs 3 and 5.
  • Primary outcome: PCT diagnostic performance to detect IAI.
  • Funding: None disclosed.

Key results

  • Variable bias risks.
  • Pooled performance for POD 5:
    • Sensitivity: 0.78 (95% CI, 0.65-0.89);
    • Specificity: 0.88 (0.85-0.90);
    • Diagnostic OR: 32.39 (15.01-69.88);
    • Area under receiver operating curve: 0.94;
    • Derived PCT cutoff value: 1.26 ng/mL on POD 5;
    • Nonsignificant heterogeneity.
  • Lesser performance before POD 5.

Limitations

  • Cutoff value requires validation.
  • Unknown whether cutoff applies to laparoscopic patients.
  • ERAS protocols may aim for discharge before POD 5.