VALUE OF PROCALCITONIN IN DIFFERENTIATING INFLAMMATORY REACTION CAUSED BY FRACTURE SURGERY FROM POSTOPERATIVE INFECTIVE COMPLICATIONS

Abstract

Recently procalcitonin has become more interesting with its characteristics as a novel marker for infections rather than with its prehormone characteristics.

Effects of fracture and fracture surgery to serum procalcitonin levels and the value of procalcitonin in differentiating inflammatory reaction caused by fracture surgery from postoperative infective complications were investigated.

Twenty-nine patients (13 women, 16 men; mean age 74.7) who underwent surgery for pertrochanteric fractures were evaluated. Procalcitonin, C-reactive protein (CRP), white blood cell count and body temperature were measured before surgery and for five days postoperatively.

Nine patients developed complications; postoperative wound infection occurred in one and one was lost due to sepsis. Mean preoperative CRP level was five times above the normal. It made a peak on the second day, then began to decrease, but still was four times higher than the preoperative level on the fifth day. Preoperatively, mean procalcitonin level was lower than the normal in all patients. It made a peak on the first postoperative day without exceeding the normal range and returned to the preoperative level on the fifth day. In contrast to CRP levels which were above the normal in all patients, procalcitonin levels were higher than the normal only in patients who developed complications. Sensitivity and specificity of procalcitonin to determine systemic complications were 100% and 95.2% on the first day, respectively (cut-off value ≥0.5 ng/ml).

Procalcitonin is much superior to routinely used infection parameters based on the fact that it is not affected by the inflammatory response resulting from the surgery; it provides a faster response to surgical trauma; it declines more rapidly after removal of the factor leading to inflammatory response and it follows a standard postoperative kinetics. It can be considered as an alarm for possible complications when postoperative procalcitonin levels are above normal.