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Microalbuminuria and serum procalcitonin levels following oesophagectomy

MOLNÁR, Z.; SZAKMÁNY, T.; KÖSZEGI, T.; TEKERES, M.

European Journal of Anaesthesiology: July 2000 - Volume 17 - Issue 7 - p 464-465
Correspondence
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Department of Anaesthesia and Intensive Therapy, University of Pécs, Ifjuság 13, 7643 Pécs, Hungary (MOLNÁR, SZAKMÁNY)

Department of Clinical Chemistry, University of Pécs, Hungary (KÖSZEGI)

Department of Anaesthesia and Intensive Therapy, University of Pécs, Hungary (TEKERES)

Accepted March 2000

Correspondence: Z. Molnár.

EDITOR:

There has been a surge of interest in the fields of biological markers in critical illness over the last decade. The aim has been to detect specific signals given by the critically-ill patient to identify those at the highest risk and to predict outcome. However, a complicating factor is that the time elapsed between the initiating insult and admission to the intensive care unit (ICU) is often unknown. We have previously shown that in a heterogenous ICU patient population the presence of microalbuminuria is a rapid, sensitive and specific marker of the severity of critical illness [1]. Procalcitonin (PCT), on the other hand, has been shown by several authors to be a sensitive and specific early marker of sepsis [2]. Oesophagectomy, performed as an elective procedure carries a risk of morbidity and mortality. We investigated the course of microalbuminuria and PCT values in 35 patients following oesophagectomy. The local Ethics Committee approved the study protocol and waived the need for informed consent. Urine samples (20 mL) were taken after anaesthesia was commenced (TPreop), on arrival on ICU (T0), then at 6, 24, 48 and 72 h (T6,24,48,72) after operation. Microalbuminuria was expressed as the albumin (mg L−1): creatinine (mmol L−1) ratio (mg mmol−1). Arterial blood samples (5 mL) were taken when the patient arrived in the ICU (T0), then daily (T24,48,72) for the first 3 days after surgery. The patients' clinical progress was monitored by daily multiple organ dysfunction scores (MODS) [3]. Data is summarized as medians and interquartile ranges. For statistical analysis Wilcoxon's rank sum test was used. All patients survived the study period of 3 days. There was no significant change in the patients' clinical progress as monitored by daily MODS scores (MODS-1=2(2-3); MODS-2=2(1-3); MODS-3=3(1-4)). There was a significant increase in microalbuminuria on admission to ICU, but values returned to normal within 6 h and remained so for the rest of the study period (Fig. 1). Serum procalcitonin was in the normal range when patients arrived in the ICU, but within 24 h values increased significantly, and remained elevated for the rest of the study (Fig. 2).

Fig. 1

Fig. 1

Fig. 2

Fig. 2

It has been shown that inflammatory stimuli can alter the permeability of the endothelium resulting in capillary leakage [4]. This can lead to increased renal albumin excretion that has been observed following trauma, surgery, and pancreatitis [5]. Although serum PCT is thought to be the most important marker of bacterial sepsis, elevated values have been found in patients following trauma and surgery with no signs of bacterial infection [6,7]. The serum PCT values correlated well with the injury severity score and tissue damage in trauma patients and increased concentrations were measured in 95% of patients who had surgery of the gastrointestinal tract.

Our current results are in accord with these previous findings. However, this is one of the first studies to identify the different times at which the maximum response is achieved by these two biological markers. This significant increase in microalbuminuria and serum PCT levels could be a normal response to upper gastrointestinal tract surgery, as there was no significant deterioration in organ function as monitored by daily MODS scores during the first three postoperative days. Further investigations are required to have a better understanding of marker kinetics in those patients who develop organ dysfunction.

Z. MOLNÁR

T. SZAKMÁNY

Department of Anaesthesia and Intensive Therapy, University of Pécs, Ifjuság 13, 7643 Pécs, Hungary

T. KÖSZEGI

Department of Clinical Chemistry, University of Pécs, Hungary

M. TEKERES

Department of Anaesthesia and Intensive Therapy, University of Pécs, Hungary

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References

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© 2000 European Academy of Anaesthesiology