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2013, Número 1

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Cir Gen 2013; 35 (1)


Procalcitonina como marcador de procesos infecciosos en cirugía. Conceptos actuales

Carrillo ER, Pérez CÁA

Idioma: Español
Referencias bibliográficas: 31
Paginas: 49-55
Archivo PDF: 189.15 Kb.


RESUMEN

Objetivo: Revisar conceptos actuales relacionados a la procalcitonina (PCT) para el diagnóstico y seguimiento de infecciones.
Sede: Unidad de terapia intensiva Hospital Médica Sur.
Diseño: Revisión de la literatura.
Material y métodos: Se realizó una búsqueda en la literatura con las palabras clave PCT, infección, cirugía y antibióticos, en los buscadores Ovid, Springer, Sciencedirect, EbscoHost y Pubmed para responder las siguientes preguntas: ¿Qué tan útil es la PCT para el diagnóstico de infección y sepsis en diferentes escenarios quirúrgicos?, ¿qué impacto tiene como factor pronóstico?, ¿en qué guías se ha incluido como parte del algoritmo diagnóstico y de toma de decisiones para iniciar, de-escalar y suspender antibióticos?
Resultados: De los 31 artículos incluidos en esta revisión, siete son metaanálisis, siete revisiones sistemáticas, cuatro estudios de no inferioridad, cuatro estudios de cohorte multicéntricos longitudinales, cuatro estudios observacionales experimentales y cinco estudios de casos y controles. Con base en los estudios evaluados, la procalcitonina mostró ser un marcador útil para el diagnóstico de infecciones y sepsis, con una sensibilidad del 75% (95% IC 67-76), especificidad del 80% (95% IC 76-91) con un área bajo la curva de 0.78 (95% IC 0.73-0.83). La especificidad se incrementa a 93.7% (95% IC 0.85-0.97) con puntos de corte por arriba de 2 ng/ml. La terapia antimicrobiana dirigida por PCT disminuye de manera significativa los días de exposición a antibiótico.
Conclusiones:Con base en la evidencia científica, la PCT se ha posicionado como un buen marcador para el diagnóstico de infecciones bacterianas y para tomar decisiones en cuanto a la duración de la terapia antimicrobiana


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