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Procalcitonin in elective colorectal surgery and its predictive value for an early discharge of fast-track patients


Procalcitonin (PCT) is regarded as a specific indicator of bacterial infection. Infectious complications in patients after colorectal surgery are a common cause of morbidity and mortality. The aim of this study was to investigate whether PCT could serve as a negative predictive marker for postoperative complications, and whether in patients with elevated PCT levels a preemptive treatment with the third-generation cephalosporin ceftriaxone is superior to antibiotic treatment starting later on the appearance of clinical signs and symptoms of infection.


By screening 250 patients with colorectal surgery we identified 20 patients with PCT serum levels >1.5 ng/ml on at least two of the first three postoperative days. The remaining 230 patients were followed up for the occurrence of infectious complications. The 20 patients with elevated PCT were included in a prospective randomised pilot study comparing preemptive antibiotic treatment with ceftriaxone versus standard treatment.


The negative predictive value of PCT for systemic infectious complications was 98.3%. In patients receiving preemptive antibiotic treatment (ceftriaxone), both the incidence and the severity of postoperative systemic infections were significantly lower compared with those in a control group (Pearson's chi-squared test P = 0.001 and P = 0.007, respectively). Major differences were also observed with respect to the duration of antibiotic treatment and the length of hospital stay.


PCT is an early marker for systemic infectious complications after colorectal surgery with a high negative predictive value. A significant reduction in the rate of postoperative infections in patients with elevated PCT serum concentrations was achieved by means of preemptive antibiotic treatment.

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Chromik, A., Uhl, W., Thiede, A. et al. Procalcitonin in elective colorectal surgery and its predictive value for an early discharge of fast-track patients. Crit Care 12 (Suppl 2), P185 (2008).

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