calca-protein--human and Ischemia

Intestinal ischemia is common after emergency gastrointestinal or cardiovascular surgery. At present, there are no diagnostic tools for the early diagnosis of intestinal ischemia. In the last decade, procalcitonin (PCT) has been suggested as a marker of this condition. Here, we review the use of PCT as a diagnostic tool for intestinal ischemia. Two reviewers independently searched the PubMed and EMBASE databases for articles on intestinal ischemia and PCT. They then considered (1) the criteria applicable to preclinical and clinical data; and (2) PCT's predictive value in the diagnosis of intestinal ischemia. Article quality was rated according to the STAndards for Reporting of Diagnostic accuracy. Between 1993 and 2014, seven studies (including two preclinical studies and five clinical studies) dealt with the use of PCT to diagnose intestinal ischemia. Procalcitonin's sensitivity, specificity, positive predictive value and negative predictive value ranged between 72% and 100%; 68% and 91%; 27% and 90% and 81% and 100%, respectively. The area under the receiver operating characteristic curve ranged from 0.77 to 0.92. In view of the preclinical and clinical data, we consider that PCT can be used in daily practice as a tool for diagnosing intestinal ischemia.

Topics: Animals; Area Under Curve; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Intestinal Mucosa; Intestines; Ischemia; Predictive Value of Tests; Prognosis; Protein Precursors; Risk Factors; Signal Transduction

Procalcitonin (PCT) is a relatively new, promising indirect parameter for infection. In the intensive care unit (ICU) it can be used as a marker for sepsis. However, in the ICU there is a need for reliable markers for clinical deterioration in the critically ill patients. This study determines the clinical value of PCT concentrations in recognizing surgical complications in a heterogeneous group of general surgical patients in the ICU.. We prospectively collected PCT concentration data from April 2010 to June 2012 for all general surgical patients admitted to the ICU. Both the relationships between PCT levels and events (diagnostic and therapeutic interventions) as well as between PCT levels and surgical complications (abscesses, bleeding, perforation, ischemia, and ileus) were studied.. PCT concentrations were lower in patients who developed complications than those who did not develop complications on the same day, although not significant (P = 0.27). A 10% increase in PCT levels resulted in a 2% higher complication odds, but again this was not significant (odds ratio [OR], 1.020; 95% confidence interval [CI], 0.961-1.083; P = 0.51). Even a 20% or 30% increase in PCT concentrations did not result in higher complication probability (OR, 1.039; 95% CI, 0.927-1.165 and OR, 1.057; 95% CI, 0.897-1.246). Furthermore, an increase in PCT levels did not show an increase or a reduction in the number of diagnostic and therapeutic interventions.. An increase in PCT levels does not help to predict surgical complications in critically ill surgical patients.

Topics: Abscess; Aged; Aged, 80 and over; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Female; Hospital Mortality; Humans; Ileus; Intensive Care Units; Ischemia; Male; Middle Aged; Postoperative Hemorrhage; Prognosis; Prospective Studies; Protein Precursors; Sepsis; Surgical Wound Infection

Ischemia and necrosis are complications of small bowel obstruction (SBO) and require rapid surgical treatment. At present, there are no sufficiently accurate preoperative biomarkers of ischemia or necrosis. The objective of the current study was to evaluate the value of serum procalcitonin levels for predicting conservative management failure and the presence of intraoperatively observed bowel ischemia (reversible or not) in patients with SBO.. One hundred and sixty-six participants of 242 in a randomized controlled trial focusing on the management of SBO (Acute Bowel Obstruction Diagnostic study [ABOD], NCT00389116) had available data on procalcitonin and were included in the study. The primary study objective was to determine whether serum procalcitonin could identify patients in whom conservative management (CM) failed (the surgical management [SM] group) and the subset of SM patients with intraoperatively observed ischemia (reversible or not). For the analysis, the patients were divided into subgroups according to the success or failure of CM and (for surgically managed patients) the presence or absence of intraoperative ischemia (reversible or not).. Procalcitonin levels were higher in the SM group (n = 35) than in the CM group (n = 131) (0.53 vs 0.14 ng/mL; p = 0.031) and higher in the group managed surgically with ischemia (n = 12) than patients managed surgically without intraoperative ischemia (n = 23) (1.16 vs 0.21 ng/mL, respectively; p < 0.001). A multiple logistic regression showed that procalcitonin is a risk factor for CM failure (odds ratio = 3.5; 95% CI, 1.4-8.5; p = 0.006) and for ischemia (reversible or not) (odds ratio = 46.9; 95% CI, 4.0-547.3; p < 0.001).. Procalcitonin can help predict CM failure and occurrence of bowel ischemia (reversible or not) in SBO patients, but additional studies are needed.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Intestinal Obstruction; Intestine, Small; Ischemia; Logistic Models; Male; Middle Aged; Necrosis; Odds Ratio; Predictive Value of Tests; Protein Precursors; Randomized Controlled Trials as Topic; Treatment Failure

To our knowledge, the predictive value of procalcitonin for bowel strangulation has been evaluated in only 2 experimental studies that had conflicting results. The objective of this study was to evaluate the value of procalcitonin for early diagnosis of intestinal ischemia and necrosis in acute bowel obstruction.. We performed a prospective study of 242 patients with small- or large-bowel obstructions in 2005. A total of 100 patients who underwent operation were divided into groups according to the presence of ischemia (reversible and irreversible) and necrosis, respectively, as follows: ischemia (n = 35) and nonischemia groups (n = 65) and necrosis (n = 22) and nonnecrosis groups (n = 78). Data analyzed included age, sex, vital signs, symptoms, clinical findings, white blood cell count, base deficit, metabolic acidosis, procalcitonin levels on presentation, the time between symptom onset and arrival at the emergency department and the time between arrival and operation, and the cause of the obstruction.. Procalcitonin levels were greater in the ischemia than the nonischemia group (9.62 vs 0.30 ng/mL; P = .0001) and in the necrosis than the non-necrosis group (14.53 vs 0.32 ng/mL; P = .0001). Multivariate analysis identified procalcitonin as an independent predictor of ischemia (P = .009; odds ratio, 2.252; 95% confidence interval, 1.225-4.140) and necrosis (P = .005; odds ratio, 2.762; 95% confidence interval, 1.356-5.627). Using receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) of procalcitonin for ischemia and necrosis was 0.77 and 0.87, respectively. A high negative predictive value for ischemia and necrosis of procalcitonin levels <0.25 ng/mL (83% and 95%, respectively) and a positive predictive value of procalcitonin >1 ng/mL were identified (95% and 90%, respectively).. Procalcitonin on presentation is very useful for the diagnosis or exclusion of intestinal ischemia and necrosis in acute bowel obstruction and could serve as an additional diagnostic tool to improve clinical decision-making.

Topics: Adult; Aged; Area Under Curve; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Intestinal Obstruction; Intestines; Ischemia; Male; Middle Aged; Multivariate Analysis; Necrosis; Predictive Value of Tests; Prospective Studies; Protein Precursors

The aim of this study was to look for preoperative and postoperative prognostic factors for early mortality, likely to be of use to clinicians in decision making.. Prospective multicenter study.. This study was conducted in 4 university hospitals in Northeast France.. One hundred thirty-one patients with mesenteric infarction confirmed by pathologic examination were included.. All patients underwent surgery and were hospitalized in the intensive care unit.. Twenty-eight patients (21.3%) underwent exploratory laparotomy only; 103 patients underwent bowel resection with/or without associated revascularization. The overall mortality rate at discharge was 74.8%. In the first 3 days, 60% of deaths occurred. The prognostic factors for death within 72 hours, obtained by logistic regression, were preoperative heart failure, lactate level over 5 mmol/L, aspartate aminotransferase over 200 IU/L, and total cholesterol level below 80 mg/dL, or procalcitonin level over 40 ng/L. From these results, a mortality prognostic score was derived. Probability of mortality within 72 hours was estimated to be 5% for patients with none of these factors and 97% for those with all 4. For deaths occurring after 72 hours, the only mortality prognostic factor was the existence of necrosed areas at the ends of bowel resections.. When patients have fewer than 3 of the prognostic factors described in the score, aggressive medical and surgical strategies could be appropriate. If necrosis is recorded at the ends of the resection, renewed surgery should be undertaken as soon as signs of new disturbances appear.

Topics: Aged; Aspartate Aminotransferases; Calcitonin; Calcitonin Gene-Related Peptide; Cholesterol; Female; France; Heart Failure; Humans; Infarction; Ischemia; Lactic Acid; Male; Mesentery; Postoperative Complications; Prognosis; Prospective Studies; Protein Precursors; Risk Factors; Surgical Procedures, Operative; Survival Analysis; Time Factors; Treatment Outcome