Serum Procalcitonin for Predicting the Failure of Conservative Management and the Need for Bowel Resection in Patients with Small Bowel Obstruction

详细信息    查看全文

• 作者：Cyril Cosse ; PhD^a ; ^b ; Jean Marc Regimbeau ; MD ; PhD^a ; ^c ; ^{regimbeau.jean-marc@chu-amiens.fr} ; David Fuks ; MD^a ; ^b ; Franç ; ois Mauvais ; MD^d ; Michel Scotte ; MD ; PhD^e
• 关键词：ABOD ; Acute Bowel Obstruction Diagnostic study ; AUROCC ; area under the receiver operating characteristic curve ; CM ; conservative management ; OR ; odds ratio ; PCT ; procalcitonin ; SBO ; small bowel obstruction ; SI&minus ; managed surgically without ischemia
• 刊名：Journal of the American College of Surgeons
• 出版年：2013
• 出版时间：May, 2013
• 年：2013
• 卷：216
• 期：5
• 页码：997-1004
• 全文大小：347 K

文摘

| Figures/TablesFigures/Tables | ReferencesReferences

Background

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.

Study Design

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], ) 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).

Results

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).

Conclusions

Procalcitonin can help predict CM failure and occurrence of bowel ischemia (reversible or not) in SBO patients, but additional studies are needed.