Biomarkers of inflammatory in tertiary peritonitis

O.B. Matviychuk

Abstract


Background. Secondary peritonitis is the most common complication of acute surgical abdominal pathologies. Procalcitonin and C-reactive protein are the biomarkers of abdominal sepsis. The markers of the state of a patient with tertiary peritonitis are not yet studied enough. The purpose of the study was to study the levels of procalcitonin and C-reactive protein in secondary and tertiary peritonitis. Materials and methods. The study involved 109 cases of se­condary peritonitis. The signs of tertiary peritonitis appeared on the 3rd — 12th day (median 5th day) in 20 operated patients (18.3 %). Tertiary peritonitis had negative outcome in 90 cases. Results. The patients were divided into two groups: with secondary (n = 89) and tertiary (n = 20) peritonitis. The patients with secondary peritonitis at admission had enhances procalcitonin level (median 5.6 ng/ml (min 0.1; max 35.1 ng/ml)), decreasing to the 3rd day (median 4.2 ng/ml (min 0.4; max b17.6 ng/ml)) and the 7th day (median 2.1 ng/ml (min 0.3; max 22.3 ng/ml)). The patients with tertiary peritonitis had increased procalcitonin level at admission (median 10.4 ng/ml (min 0.1; max 35.9 ng/ml)), decreasing to the 3rd day (median 5.3 ng/ml (min 0; max 28.1 ng/ml)), enhancing while tertiary peritonitis developed (median 5.2 ng/ml (min 2.2; max 18.9 ng/ml)), being statistically more increased (p < 0.05) than those in patients with secondary peritonitis. At admission both groups had no statistically significant difference in C-reactive protein concentration (median 44.1 mg/ml (min 8.1; max 48.1 mg/ml) in patients with secondary peritonitis versus median 43.85 mg/ml (min 31.7; max 45 mg/ml) in tertiary peritonitis). C-reactive protein level had the similar trend on the 7th day (19.1 mg/ml (min 4.5; max 45.1 mg/ml) versus 19.2 mg/ml (min 6.6; max 41.6 mg/ml)). The statistically significant difference (p < 0.05) in C-reactive protein level was registered on the 3rd day after surgical intervention with decreased concentration in tertiary peritonitis (26.15 mg/ml (min 1.7; max 38.1 mg/ml) versus 31.1 (min 7.4; max 84.1 mg/ml)). Conclusions. Tertiary peritonitis is the most complicated type of abdominal sepsis to be diagnosed and cured with high lethality rate. Procalcitonin level increases with tertiary peritonitis development. C-reactive protein level decrease on the 3rd day after surgical intervention is an indicator of tertiary peritonitis development.


Keywords


secondary peritonitis; tertiary peritonitis; procalcitonin; C-reactive protein

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DOI: https://doi.org/10.22141/1997-2938.2.33.2017.107648

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