Serum procalcitonin and C reactive protein as early detectors of anatomotic leakage.
Procalcitonina y proteína C reactiva como marcadores precoces de falla de sutura digestiva.
Resumen:
Anastomotic leakage in digestive sutures determines high morbidity and mortality, but its early diagnoses is critical and controversial. There is an important interest on finding an early detection biomarker that allows early diagnoses without clinical evidences. Many studies have shown the eficacy of Procalcitonin (PCT) and C Reactive Protein (CRP) as early detection biomarkers of anastomotic leackeage, as they were demostrated as useful intraabdominal infection predictors. This prospective observational study took place in Hospital Maciel, Department of Surgery nº 3, in a period of 14 months, and included all patients undergoing elective surgery with a digestive suture. CRP and PCT were measured preoperatively and on postoperative days (POD) 1, 2, 3, 4, 5 and patients were followed for postoperative complications with the aim to determine if they were suitable as anastomotic leackage monitoring tool in the postoperative setting. We established two groups: with and without anastomotic leackage.28 patients were included. 14,3% corresponded to the anastomotic leackage group with a mortality of 3,6%. We found a statistically significative increase of both biomarkers in the leackage group (CRP p=0,001 and PCT p=0,003) with a remarkable increase specially POD 3. The main limitation of the study is the small number of patients. There was no statistically difference in demographic characteristics between groups. According to our results, postoperative PCT and CRP determination can be use as adecuated early predictors of anastomoticleackage from the POD 2.
La falla de sutura digestiva conlleva alta morbi-mortalidad y su diagnóstico precoz es un punto crítico y controversial. Se ha considerado necesario encontrar un marcador bioquímico de valor diagnóstico en ausencia de cuadro clínico evidente.Hay creciente evidencia de la eficacia de la Procalcitonina (PCT) y Proteína C Reactiva (PCR) como marcadores precoces de falla de sutura digestiva, porque ambas han mostrado ser útiles para la predicción de infección intrabdominal.Se realizó en el Hospital Maciel/ Clínica quirúrgica “3” (perío-do: 14 meses) , un estudio observacional, prospectivo, inclu-yendo todos los pacientes intervenidos de coordinación a los que se realizó una sutura digestiva. Se realizo la medición dia-ria de PCT y PCR pre y postoperatoria por 5 días con el objeti-vo de determinar la utilidad de ambas como indicadores preco-ces de falla de sutura. Se identificaron las complicaciones y establecieron dos grupos según la aparición o no de fuga anas-tomótica, diagnosticada clínicamente y/o imagenológicamente.Se incluyeron 28 pacientes, 14,3% presentaron falla de sutura con una mortalidad de 3,6%. Se encontró un aumento significativo de ambos marcadores en el grupo de falla de sutu-ra (PCR p=0,001yPCT p=0,003) con un aumento específico en el 3er día de postoperatorio.La limitante de nuestro estudio es el bajo número de casos, en lo cual no se encontró diferencia significativa en el resto de las variables analizadas.Este estudio permite inferir que la PCR y la PCT deben consi-derarse adecuados predictores precoces de falla de sutura y de infección intra-abdominal, a partir de las 48 hs de postoperato-rio.
2019 | |
sutura digestiva procalcitonina proteína C reactiva falla de sutura suture calprotectin c reactive protein anastomotic leackage |
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Español | |
Sociedad de Cirugía del Uruguay | |
Revista Cirugía del Uruguay | |
https://revista.scu.org.uy/index.php/cir_urug/article/view/40 | |
Acceso abierto |
Sumario: | Anastomotic leakage in digestive sutures determines high morbidity and mortality, but its early diagnoses is critical and controversial. There is an important interest on finding an early detection biomarker that allows early diagnoses without clinical evidences. Many studies have shown the eficacy of Procalcitonin (PCT) and C Reactive Protein (CRP) as early detection biomarkers of anastomotic leackeage, as they were demostrated as useful intraabdominal infection predictors. This prospective observational study took place in Hospital Maciel, Department of Surgery nº 3, in a period of 14 months, and included all patients undergoing elective surgery with a digestive suture. CRP and PCT were measured preoperatively and on postoperative days (POD) 1, 2, 3, 4, 5 and patients were followed for postoperative complications with the aim to determine if they were suitable as anastomotic leackage monitoring tool in the postoperative setting. We established two groups: with and without anastomotic leackage.28 patients were included. 14,3% corresponded to the anastomotic leackage group with a mortality of 3,6%. We found a statistically significative increase of both biomarkers in the leackage group (CRP p=0,001 and PCT p=0,003) with a remarkable increase specially POD 3. The main limitation of the study is the small number of patients. There was no statistically difference in demographic characteristics between groups. According to our results, postoperative PCT and CRP determination can be use as adecuated early predictors of anastomoticleackage from the POD 2. |
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