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The Role of Procalcitonin in Gynaecological Surgery

We evaluated postoperative concentrations of inflammatory indicators, including procalcitonin, after gynaecological operations for benign and malignant tumours in patients with a normal postoperative course and assessed the utility of procalcitonin in differentiating between non-bacterial inflammation and bacteraemic complications in the postoperative period. This prospective study included 99 patients: 47 after a standard gynaecological operation (Piver I) and no postoperative infectious complications (group 1), 35 after a major procedure (Piver II or III) and no postoperative infectious complications (group 2), and five with postoperative sepsis after Piver II or III procedures (group 3). We also studied serum procalcitonin concentrations in a group of 12 patients (group 4) with terminal forms of gynaecological cancer who were hospitalized for palliative treatment but did not undergo surgery. Postoperative C-reactive protein (CRP) concentration corresponded with extent of tissue trauma in groups 1 and 2 and was significantly lower in group 1 than group 2. Inflammatory indicators were highest in groups 1 and 2 on postoperative day 2. In group 3, in which sepsis developed, values were highest on postoperative day 4. In particular, procalcitonin was > 2 ng/ml in all patients with postoperative sepsis by postoperative day 2 but was always ≤ 2 ng/ml in patients without sepsis. In contrast, high procalcitonin levels were noted in the patients in group 4 compared with group 3, with two-thirds of group 4 patients having levels > 2 ng/ml, with no signs of infection or raised CRP. It is concluded that, for early detection of postoperative infectious complications after gynaecological surgery, procalcitonin levels > 2 ng/ml are more specific than CRP.