Serum C-Reactive Protein, Procalcitonin and Lactate Levels as Predictors of Postoperative Surgical Site Infections
DOI:
https://doi.org/10.53350/pjmhs02026203.5Keywords:
C-reactive protein, Procalcitonin, Lactate, Surgical site infection; Postoperative complications, BiomarkersAbstract
Background: Surgical site infections (SSIs) continue to be a significant source of morbidity, extended hospital stay and the associated costs after surgery. Predicting the risk of SSI early in the postoperative period is crucial for early intervention and better outcomes. Biomarkers including C-reactive protein (CRP), procalcitonin (PCT), and serum lactate can potentially predict the occurrence of postoperative infection before clinical symptoms manifest.
Objective: To assess the predictive ability of serum C-reactive protein (CRP), procalcitonin (PCT) and lactate for postoperative surgical site infections (SSIs) in surgical patients.
Methods: The study was a prospective observational study conducted in the Department of Surgery Department of Surgery, Ghulam Muhammad Mahar Medical College Teaching Hospital, Sukkur, a tertiary care teaching hospital from 1st June 2023 to 31st January 2025. We recruited 150 consecutive patients in the postoperative period. CRP, procalcitonin and lactate were measured in the immediate postoperative period. The patients were clinically monitored for the occurrence of SSI according to the diagnostic criteria. Demographic, clinical, and surgical data were also collected. SPSS version 26.0 was used for data analysis, and independent sample t-test and chi-square test were used to compare patients with and without SSI.
Results: Thirty nine (26%) patients developed SSI. The mean CRP (91.3±23.6 mg/L), procalcitonin (2.58±0.91 ng/mL) and lactate (3.28±0.76 mmol/L) levels were significantly higher in patients with SSI than those without (p<0.001 for all). SSI was also significantly associated with increased BMI, diabetes mellitus, emergency surgery, and longer operative time. SSI was associated with longer hospital stay and wound complications.
Conclusion: Serum C-reactive protein, procalcitonin, and lactate are valuable early predictors of postoperative surgical site infections. Procalcitonin had the highest predictive value. Their use in the postoperative period may assist in early diagnosis and management of SSI.
References
Aljabi Y, Manca A, Ryan J, Elshawarby A. Value of procalcitonin as a marker of surgical site infection following spinal surgery. Surgeon. 2019;17(2):97-101.
Aslan Cetin B, AydoganMathyk B, Koroglu N, Temel Yuksel I, Konal M, Erenel H, et al. Serum procalcitonin levels in incisional surgical site infections requiring a secondary suture after cesarean sections. J Matern Fetal Neonatal Med 2019;32(24):4108-13.
Gill MK, Kukreja S. Serum procalcitonin as diagnostic marker for postoperative surgical wound infection. Trop J Pathol Microbiol 2019; 5(8):602-7.
Bavare A, Rissmiller B, Devaraj S, Guffey D, Rajapakshe D, Weiner H, et al. Perioperative procalcitonin in predicting infection in children undergoing surgical procedures. J Surg Res 2021; 258:332-8.
Silvetti S, Lembo R, Mesini A, Landoni G, Castagnola E, Nuri H, et al. Procalcitonin and early postoperative infection after pediatric cardiopulmonary bypass surgery. J Cardiothorac Vasc Anesth 2021;35(12):3688-93.
Chen G, Yi H, Zhang J. Diagnostic value of C-reactive protein and procalcitonin for postoperative pancreatic fistula following pancreatoduodenectomy: a systematic review and meta-analysis. Gland Surg 2021;10(12): 3252-63.
Das U, Anandhi A, Sureshkumar S, Sastry AS, Subitha L. Procalcitonin and C-reactive protein as an early predictor of infection in elective gastrointestinal cancer surgery: a prospective observational study. Indian J Surg Oncol 2022;53(3):605-13.
Hassan J, Khan S, Zahra R, Razaq A, Zain A, Razaq L, et al. Role of procalcitonin and C-reactive protein as predictors of sepsis and in managing sepsis in postoperative patients: a systematic review. Cureus 2022;14(11): e31067.
De Cicco Nardone C, De Luca C, Plotti F, Fabris S, Rossini G, Montera R, et al. C-reactive protein “at first sight”: standard postoperative trend in gynecological surgery and a comparative analysis with white blood cell levels. Int J Gynaecol Obstet 2023; 160(1):237-43.
Jerome E, McPhail MJ, Menon K. Diagnostic accuracy of procalcitonin and interleukin-6 for postoperative infection in major gastrointestinal surgery: a systematic review and meta-analysis. Ann R Coll Surg Engl 2022;104(8): 561-70.
Appiah-Danquah R, Boateng R, Botchway E, Antwi-Kusi A, Oduro B, Twumasi S, et al. C-reactive protein is a diagnostic tool for postoperative infection in orthopaedics. Cureus 2022;14(3):e22957.
Bona D, Danelli P, Sozzi A, Sanzi M, Cayre L, Lombardo F, et al. C-reactive protein and procalcitonin levels to predict anastomotic leak after colorectal surgery: systematic review and meta-analysis. J Gastrointest Surg 2023;27(1): 166-79.
Cohen NS, Bock JM, May AK. Sepsis and postoperative surgical site infections. Surgery 2023;174(2):403-5.
Erciyestepe SG, Boran AB, Yildirim MS, Erciyestepe M. Is it possible to predict surgical site infection? Malawi Med J 2023;35(3):190-95.
Nicolotti D, Grossi S, Palermo V, Pontone F, Maglietta G, Diodati F, et al. Procalcitonin for the diagnosis of postoperative bacterial infection after adult cardiac surgery: a systematic review and meta-analysis. Crit Care 2024;28(1):44.
Pattou M, Fuks D, Guilbaud T, Le Floch B, Lelièvre O, Tribillon E, et al. Predictive value of C-reactive protein for postoperative liver-specific surgical site infections. Surgery 2024;175(5):1337-45.
Perrella A, Giuliani A, De Palma M, Castriconi M, Molino C, Vennarecci G, et al. C-reactive protein but not procalcitonin may predict antibiotic response and outcome in infections following major abdominal surgery. Intern Emerg Med 2022;17(3):765-71.
World Health Organization. Global guidelines for the prevention of surgical site infection. 2nd ed. Geneva: World Health Organization; 2023.
Centers for Disease Control and Prevention. Surgical site infection (SSI) event. Atlanta: CDC; 2024.
Allegranzi B, Zayed B, Bischoff P, Kubilay NZ, de Jonge S, de Vries F, et al. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis 2019;19(12): e288-303.
Downloads
How to Cite
Issue
Section
License
Copyright (c) 2026 DHARMOON ARIJA, SHAHID HUSSAIN MIRANI, ZAIN-UL-ABIDEEN, TAHIRA RASHEED, HALAR HABIBULLAH, RUKKIA SAFDAR
This work is licensed under a Creative Commons Attribution 4.0 International License.
