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Letters to the Editor

Reply to Apostolakis et al.

Division of General Thoracic Surgery, University Hospital Berne, Switzerland

Received 20 October 2008; accepted 21 October 2008.

^_* Corresponding author. Address: Division of General Thoracic Surgery, University Hospital Berne/Inselspital, 3010 Berne, Switzerland. Tel.: +41 31 632 2111. (Email: beatrix.hoksch{at}insel.ch).

Key Words: Procalcitonin • Pleural empyema • Decortication

We would like to thank Dr Apostolakis for his valuable comment on our recently published results on procalcitonin (PCT) in the postoperative course after decortication in case of pleural empyema [1,2].

The point of the study was the observation of the postoperative course of PCT in comparison to CrP. We registered that PCT seems ‘to reflect the postoperative clinical course more accurately than CrP’ and has had ‘a good correlation with the postoperative course in case of SIRS or sepsis’ [2]. On the other hand low preoperative levels of PCT, as was the case in two patients (9.1%), do not exclude a localized (without systemic signs) infection. The patient with the postoperative recurrent pleural effusions showed a preoperative level of 0.35 ng/ml. This is not a low level but rather a sign of an infection, yet not necessarily a systemic one (serum or plasma PCT concentrations of healthy persons are measured with the Kryptor-assay are below 0.06 ng/ml [3]).

If there was only the sneaking suspicion that a pleural empyema was due to tuberculosis (clinic, anamnesis) this patient was excluded from the trial from the beginning of treatment. So not one of the patients in the presented study had tuberculosis.

We are sure that in case of an earlier availability of the PCT values most of the patients with an antibiotic treatment after discharge would not have received antibiotics (up to 85.7%). ‘So the use of PCT instead of CrP in the postoperative course after decortication could save at least 7 days of antibiotic treatment’ [2]. This is in accordance with other trials [4,5].

Indeed, the number of patients is small, in this prospective, but not randomized trial. And it is known that PCT levels show a wide variation but: ‘In general dynamics of PCT levels, rather than the absolute values, may be more important for identifying patients with persistent infection or infectious complications after surgery’ [2].

Therefore we also think it is very important to have randomized studies with more patients, maybe in a multicenter trial. These studies should determine the value of PCT as a promising marker in thoracic surgery not only after decortication in case of pleural empyema.

References

1. Apostolakis E, Prokakis C, Dougenid D. Are procalcitonin levels sufficient for the follow up of patients undergoing lung decortications for pleural empyema?. Eur J Cardiothorac Surg 2009;35:194.[Free Full Text]
2. Carboni G, Fahrner R, Gazdhar A, Printzen G, Schmid RA, Hoksch B. Comparison of procalcitonin and CrP in the postoperative course after lung decortications. Eur J Cardiothorac Surg 2008;33(5):777-780.[Abstract/Free Full Text]
3. Morgenthaler NG, Struck J, Fischer-Schulz C, Seidel-Mueller E, Beier W, Bergmann A. Detection of procalcitonin (PCT) in healthy controls and patients with local infection by a sensitive ILMA. Clin Lab 2002;48(5–6):263-270.[Medline]
4. Hochreiter M, Köhler T, Schweiger AM, Keck FS, Bein B, von Spiegel T, Schröder S. Antibiotic treatment of surgical intensive care patients: procalcitonin to guide duration of therapy. Anaesthesist 2008;57(6):571-577.[CrossRef][Medline]
5. Stolz D, Crist-Crain M, Bingisser R, Leuppi J, Miedinger D, Mueller C, Huber P, Mueller B, Tamm M. Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy. Chest 2007;131(1):9-19.[CrossRef][Medline]

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				B. Hoksch and R. A. Schmid Reply to Apostolakis et al. Eur. J. Cardiothorac. Surg., January 1, 2009; 35(1): 194 - 194. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ralph Alexander Schmid Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hoksch, B. Articles by Schmid, R. A. Search for Related Content PubMed Articles by Hoksch, B. Articles by Schmid, R. A. Related Collections Lung - other Pleura