calca-protein--human and Aortic-Aneurysm--Abdominal

A prospective clinical study was performed to assess the accuracy of procalcitonin in 70 patients with elective colorectal or aortal surgery and to compare it with inflammatory mediators. Also the early prediction of complications and the outcome of these patients was taken into account.. Laboratory variables and cytokine determination were obtained preoperatively, on the day of operation and postoperatively on a daily basis from day 1 to 5, and on days 7 and 10 in the colorectal group and in the aortal surgery group at different times on the operation day after aortal clamping. The main outcome criteria were early recognition of complications and alterations in the production of procalcitonin and cytokines in order to detect severe infective complications.. Procalcitonin was closely related to postoperative complications with significantly elevated levels at day 1 after surgery. The plasma concentrations of IL-6 increase on days 1-3 without a difference in the groups, also C-reactive protein demonstrates no differences.. Procalcitonin presents itself as a new parameter of infection and sepsis. In the postoperative period PCT seems to be an interesting marker of early prediction of infective complications when high postoperative levels are found. Under routine conditions procalcitonin is a valid reproducible and detectable parameter.

Topics: Adult; Aged; Aortic Aneurysm, Abdominal; Aortic Diseases; Arteriosclerosis; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Colectomy; Colonic Diseases; Elective Surgical Procedures; Female; Glycoproteins; Humans; Interleukin-6; Male; Middle Aged; Postoperative Complications; Prospective Studies; Protein Precursors

Endovascular repair of AAA's using stent grafts is considered to be a minimally invasive procedure. However, in some cases deleterious inflammatory reactions, e.g., flu-like postinterventional symptoms are observed. A few patients even develop a fatal "postimplantation syndrome". It is not clear whether these postoperative complications result from a) the inflammatory and immune response to the inserted graft material, b) alterations of the vascular endothelium during the implantation procedure, c) residual thrombotic material, or d) a combination of all these causes. This clinical trial aimed to prospectively investigate the association between inflammatory mediators like interleukin-1 receptor antagonist (IL-1RA), IL-6, and HLA-DR expression on monocytes and clinical outcome in patients after repair of abdominal aortic aneurysms (AAA). Fifteen patients treated with endovascular stent grafts for abdominal aortic aneurysm (AAA-E) were compared with 15 selected control patients who underwent a conventional surgical procedure (AAA-K) during the same period. Prior to intervention, there were no significant differences in marker levels. One hour postoperatively, IL-6 (421 pg/ml vs. 21 pg/ml) and IL-1RA (10,061 pg/ml versus 407 pg/ml) were significantly increased in the AAA-K-group, whereas in AAA-E patients, these parameters increased more gradually during the first postoperative day and did not reach the same level as in the control group. There was only a slight reduction of HLA-DR expression in both groups compared with baseline and no signs indicating a postimplantation syndrome were found. No excessive inflammatory response or complicated final outcome were observed. It is unclear if this can be explained by the prophylactic use of indometacin.

Topics: Adult; Aged; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis Implantation; Calcitonin; Calcitonin Gene-Related Peptide; Endothelium, Vascular; Female; Foreign-Body Reaction; HLA-DR Antigens; Humans; Immunity, Cellular; Interleukin 1 Receptor Antagonist Protein; Interleukin-6; Male; Middle Aged; Minimally Invasive Surgical Procedures; Monocytes; Postoperative Complications; Prospective Studies; Protein Precursors; Sialoglycoproteins; Stents; Systemic Inflammatory Response Syndrome