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The Value of Serum Procalcitonin Level for Differentiation of Infectious from Noninfectious Causes of Fever After Orthopaedic Surgery

Hunziker, Sabina MD; Hügle, Thomas MD; Schuchardt, Katrin MD; Groeschl, Isabelle MD; Schuetz, Philipp MD; Mueller, Beat MD; Dick, Walter MD; Eriksson, Urs MD; Trampuz, Andrej MD

Journal of Bone & Joint Surgery - American Volume: January 2010 - Volume 92 - Issue 1 - p 138–148
doi: 10.2106/JBJS.H.01600
Scientific Articles
Supplementary Content

Background: Early diagnosis of postoperative orthopaedic infections is important in order to rapidly initiate adequate antimicrobial therapy. There are currently no reliable diagnostic markers to differentiate infectious from noninfectious causes of postoperative fever. We investigated the value of the serum procalcitonin level in febrile patients after orthopaedic surgery.

Methods: We prospectively evaluated 103 consecutive patients with new onset of fever within ten days after orthopaedic surgery. Fever episodes were classified by two independent investigators who were blinded to procalcitonin results as infectious or noninfectious origin. White blood-cell count, C-reactive protein level, and procalcitonin level were assessed on days 0, 1, and 3 of the postoperative fever.

Results: Infection was diagnosed in forty-five (44%) of 103 patients and involved the respiratory tract (eighteen patients), urinary tract (eighteen), joints (four), surgical site (two), bloodstream (two), and soft tissues (one). Unlike C-reactive protein levels and white blood-cell counts, procalcitonin values were significantly higher in patients with infection compared with patients without infection on the day of fever onset (p = 0.04), day 1 (p = 0.07), and day 3 (p = 0.003). Receiver-operating characteristics demonstrated that procalcitonin had the highest diagnostic accuracy, with a value of 0.62, 0.62, and 0.71 on days 0, 1, and 3, respectively. In a multivariate logistic regression analysis, procalcitonin was a significant predictor for postoperative infection on days 0, 1, and 3 of fever with an odds ratio of 2.3 (95% confidence interval, 1.1 to 4.4), 2.3 (95% confidence interval, 1.1 to 5.2), and 3.3 (95% confidence interval, 1.2 to 9.0), respectively.

Conclusions: Serum procalcitonin is a helpful diagnostic marker supporting clinical and microbiological findings for more reliable differentiation of infectious from noninfectious causes of fever after orthopaedic surgery.

Level of Evidence: Diagnostic Level II. See Instructions to Authors for a complete description of levels of evidence.

1Department of Internal Medicine, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland

2Department of Orthopaedic Surgery, University Hospital Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland

3Infectious Diseases Service, Department of Medicine, University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland. E-mail address: andrej.trampuz@chuv.ch

Copyright 2010 by The Journal of Bone and Joint Surgery, Incorporated
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