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01-05-2016 | Original Article

Procalcitonin ratio and on-demand relaparotomy for septic peritonitis: validation of the focus index (FI)

Authors: Volker Assfalg, Petra Wolf, Daniel Reim, Norbert Hüser, Georg Hellbrügge, Edouard Matevossian, Helmut Friess, Bernhard Holzmann, Klaus L. Emmanuel, Alexander R. Novotny

Published in: Surgery Today | Issue 5/2016

Abstract

Purpose

Secondary peritonitis remains challenging to manage and some recent evidence suggests that on-demand relaparotomy is more appropriate than planned relaparotomy. This study was designed to validate the predictive power of postoperative procalcitonin (PCT) changes in relation to elimination of the septic abdominal focus.

Methods

In this prospective trial, postoperative PCT serum levels were monitored in 234 surgical patients with secondary peritonitis. The PCT ratio on postoperative days (PODs) 1 and 2 (focus index; FI) was calculated and correlated with the success of the operation.

Results

A cutoff value of 1.1 was calculated for the FI. Values below 1.1 indicated insufficient elimination of the focus and values above 1.1 correlated with effective treatment. The optimal time for first PCT sampling was found to be 12–24 h after the index operation. After the respective data cleanup, successful elimination of the intraabdominal focus could be confirmed, with a sensitivity of 93 % and a specificity of 71 %.

Conclusions

The FI is a single parameter-based reliable predictor of successful surgical eradication and strengthens the on-demand relaparotomy concept as the method of choice to treat secondary peritonitis.

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Title: Procalcitonin ratio and on-demand relaparotomy for septic peritonitis: validation of the focus index (FI)
Authors: Volker Assfalg
Petra Wolf
Daniel Reim
Norbert Hüser
Georg Hellbrügge
Edouard Matevossian
Helmut Friess
Bernhard Holzmann
Klaus L. Emmanuel
Alexander R. Novotny
Publication date: 01-05-2016
Publisher: Springer Japan
Published in: Surgery Today / Issue 5/2016
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-015-1226-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Procalcitonin ratio and on-demand relaparotomy for septic peritonitis: validation of the focus index (FI)

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

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Conclusions

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