TY - JOUR
T1 - Postoperative changes in presepsin level and values predictive of surgical site infection after spinal surgery
T2 - A single-center, prospective observational study
AU - Koakutsu, Tomoaki
AU - Sato, Tetsuya
AU - Aizawa, Toshimi
AU - Itoi, Eiji
AU - Kushimoto, Shigeki
N1 - Funding Information:
From the *Department of Emergency and Critical Care Medicine, Graduated School of Medicine, Tohoku University, Sendai, Japan; and †Department of Orthopaedic Surgery, Graduated School of Medicine, Tohoku University, Sendai, Japan. Acknowledgment date: March 27, 2017. First revision date: June 25, 2017. Second revision date: July 19, 2017. Acceptance date: August 2, 2017. The device that is the subject of this manuscript is not FDA-approved for this indication and is not commercially available in the United States. ZENKYOREN (National Mutual Insurance Federation of Agricultural Cooperatives), a grant (#JP16K10907) from JSPS (Japan Society for the Promotion of Science) KAKENHI, and a grant (#25462810) from JSPS (Japan Society for the Promotion of Science) KAKENHI funds were received in support of this work. No relevant financial activities outside the submitted work. Address correspondence and reprint requests to Tomoaki Koakutsu, MD, Department of Emergency and Critical Care Medicine, Graduated School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan; E-mail: koakutsu@med.tohoku.ac.jp
Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc.
PY - 2018/4/15
Y1 - 2018/4/15
N2 - Study Design. Single-institutional, prospective observational study. Objective. To elucidate the perioperative kinetics of presepsin (PSEP) in patients undergoing spinal surgery, and to evaluate the possibility of PSEP in the early diagnosis of surgical site infection (SSI). Summary of Background Data. Early diagnosis of SSI after spinal surgery is important. Although several biomarkers have been used as early indicators of SSI, the specificity of these markers in SSI diagnosis was not high. PSEP was found as a novel diagnostic marker for bacterial sepsis in 2004. However, its kinetics after spinal surgery and its usefulness in early diagnosis of SSI have never been evaluated. Methods. A total of 118 patients who underwent elective spinal surgery were enrolled. PSEP was measured before, immediately after, 1 day after, and 1 week after surgery. In patients without postoperative infection, perioperative kinetics of PSEP were analyzed. PSEP levels in patients with postoperative infection were also recorded separately, and their utility in SSI diagnosis was evaluated. Results. In the 115 patients without postoperative infection, the median PSEP value was 126, 171, 194, and 147 pg/mL before, immediately after, 1 day after, and 1 week after surgery, respectively. Compared with the preoperative value, PSEP was significantly higher immediately after surgery and the next day, and return to the preoperative level 1 week after surgery. The estimated reference value for 95 percentile in patients without postoperative infection was 297 pg/mL 1 week after surgery. In three patients with postoperative infection, higher levels (>300 pg/mL) were observed 1 week after surgery. Conclusion. In patients after spinal surgery without infectious complications, blood levels of PSEP may immediately increase and return to preoperative levels 1 week after surgery. The PSEP value of 300 pg/mL 1 week after surgery might be used as a novel indicator for suspected SSI.
AB - Study Design. Single-institutional, prospective observational study. Objective. To elucidate the perioperative kinetics of presepsin (PSEP) in patients undergoing spinal surgery, and to evaluate the possibility of PSEP in the early diagnosis of surgical site infection (SSI). Summary of Background Data. Early diagnosis of SSI after spinal surgery is important. Although several biomarkers have been used as early indicators of SSI, the specificity of these markers in SSI diagnosis was not high. PSEP was found as a novel diagnostic marker for bacterial sepsis in 2004. However, its kinetics after spinal surgery and its usefulness in early diagnosis of SSI have never been evaluated. Methods. A total of 118 patients who underwent elective spinal surgery were enrolled. PSEP was measured before, immediately after, 1 day after, and 1 week after surgery. In patients without postoperative infection, perioperative kinetics of PSEP were analyzed. PSEP levels in patients with postoperative infection were also recorded separately, and their utility in SSI diagnosis was evaluated. Results. In the 115 patients without postoperative infection, the median PSEP value was 126, 171, 194, and 147 pg/mL before, immediately after, 1 day after, and 1 week after surgery, respectively. Compared with the preoperative value, PSEP was significantly higher immediately after surgery and the next day, and return to the preoperative level 1 week after surgery. The estimated reference value for 95 percentile in patients without postoperative infection was 297 pg/mL 1 week after surgery. In three patients with postoperative infection, higher levels (>300 pg/mL) were observed 1 week after surgery. Conclusion. In patients after spinal surgery without infectious complications, blood levels of PSEP may immediately increase and return to preoperative levels 1 week after surgery. The PSEP value of 300 pg/mL 1 week after surgery might be used as a novel indicator for suspected SSI.
KW - Biomarker
KW - Complication
KW - Early diagnosis
KW - Infection
KW - Kinetics
KW - Presepsin
KW - Soluble CD14-subtype
KW - Spine
KW - Surgery
KW - Surgical wound infection
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U2 - 10.1097/BRS.0000000000002376
DO - 10.1097/BRS.0000000000002376
M3 - Article
C2 - 28816823
AN - SCOPUS:85045204981
SN - 0362-2436
VL - 43
SP - 578
EP - 584
JO - Spine
JF - Spine
IS - 8
ER -