The value of serum procalcitonin level for differentiation of infectious from noninfectious causes of fever after orthopaedic surgery.
Détails
ID Serval
serval:BIB_6756E7D33B63
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
The value of serum procalcitonin level for differentiation of infectious from noninfectious causes of fever after orthopaedic surgery.
Périodique
The Journal of Bone and Joint Surgery. American Volume
ISSN
1535-1386[electronic]
Statut éditorial
Publié
Date de publication
2010
Volume
92
Numéro
1
Pages
138-148
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Résumé
BACKGROUND: Early diagnosis of postoperative orthopaedic infections is important in order to rapidly initiate adequate antimicrobial therapy. There are currently no reliable diagnostic markers to differentiate infectious from noninfectious causes of postoperative fever. We investigated the value of the serum procalcitonin level in febrile patients after orthopaedic surgery. METHODS: We prospectively evaluated 103 consecutive patients with new onset of fever within ten days after orthopaedic surgery. Fever episodes were classified by two independent investigators who were blinded to procalcitonin results as infectious or noninfectious origin. White blood-cell count, C-reactive protein level, and procalcitonin level were assessed on days 0, 1, and 3 of the postoperative fever. RESULTS: Infection was diagnosed in forty-five (44%) of 103 patients and involved the respiratory tract (eighteen patients), urinary tract (eighteen), joints (four), surgical site (two), bloodstream (two), and soft tissues (one). Unlike C-reactive protein levels and white blood-cell counts, procalcitonin values were significantly higher in patients with infection compared with patients without infection on the day of fever onset (p = 0.04), day 1 (p = 0.07), and day 3 (p = 0.003). Receiver-operating characteristics demonstrated that procalcitonin had the highest diagnostic accuracy, with a value of 0.62, 0.62, and 0.71 on days 0, 1, and 3, respectively. In a multivariate logistic regression analysis, procalcitonin was a significant predictor for postoperative infection on days 0, 1, and 3 of fever with an odds ratio of 2.3 (95% confidence interval, 1.1 to 4.4), 2.3 (95% confidence interval, 1.1 to 5.2), and 3.3 (95% confidence interval, 1.2 to 9.0), respectively. CONCLUSIONS: Serum procalcitonin is a helpful diagnostic marker supporting clinical and microbiological findings for more reliable differentiation of infectious from noninfectious causes of fever after orthopaedic surgery.
Mots-clé
Adult, Aged, Aged, 80 and over, Biological Markers/blood, Calcitonin/blood, Female, Fever/blood, Fever/etiology, Humans, Infection/blood, Infection/etiology, Male, Middle Aged, Orthopedic Procedures/adverse effects, Predictive Value of Tests, Protein Precursors/blood, Young Adult
Pubmed
Web of science
Création de la notice
09/02/2010 10:36
Dernière modification de la notice
20/08/2019 15:22