The importance of procalcitonin for assessing the severity of odontogenic purulent – inflammatory diseases of the soft tissues of the maxillofacial region and as a biomarker of treatment effectiveness
DOI:
https://doi.org/10.11603/2311-9624.2019.2.10397Keywords:
inflammatory diseases of the maxillofacial area, serum procalcitonin, complications, monitoring, treatmentAbstract
Summary. Odontogenic inflammatory diseases of the maxillofacial area occupy the first place among the diseases in the clinic of maxillofacial surgery. The number of complications arising from inflammatory processes is 6–40 %. The success of treatment of patients with this pathology depends on early diagnosis, an objective assessment of the severity of the condition, the conduct of personified antibiotic therapy. The biomarker procalcitonin (PCT) is consistent with the SMART concept: S – specific and sensitive, M – measurable, A – available and affordable, R – responsive and reproducible, T – timely. At present, the diagnostic role of the PCT test in the comprehensive assessment of the odontogenic inflammatory process remains inadequate.
The aim of the study – to learn the features of changes in the level of serum procalcitonin in case of odontogenic inflammatory diseases of the maxillofacial region of varying severity and its effectiveness in monitoring the treatment.
Materials and Methods. The study included 89 patients with odontogenic infections of the maxillofacial area: 34 patients with odontogenic infection of one cellular space (group I), 35 – two cellular spaces (group II); 20 – three or more cellular spaces (group III). Determination of the level of PCT in serum was performed 1 day before treatment, at 5 and 9 days with immunoassay.
Results and Discussion. In the group I, a low PCT concentration was detected throughout the observation period (0.06±0.02) ng/ml. In group II, for 1 day, the level of PCT was elevated (1.15±0.5) ng/ml. In 26% of patients, the level of PCT for the 9th day was (1.02±0.05) ng/ml, which is 17 times higher than that of group I, p<0.05. The revealed value correlated with the severity of the pathological process. In the group III, for the first day, the level of PCT was 43 times higher than the level of group I, group II – 2.36 times. Maximum PCT levels were observed in 35 % of patients in group III during the entire observation: at day 1 – (3.23±0.19) ng/ml; 5 days – (3.14±0.05) ng/ml; 9 days – (2.82±0.04) ng/ml. These patients did not notice a significant decrease in PCT. The condition of patients was assessed as moderate, severe.
Conclusions. The level of PCT blood serum of 1.5 ng/ml is evidence of further development of purulent-inflammatory process, high risk of complications and requires an assessment of the effectiveness of antibiotic therapy and causes additional intervention – an audit of the inflammatory cell.
References
Pourdanesh, F., Dehghani, N., & Azarsina, M. (2013). Pattern of odontogenic infections at a tertiary hospital in Tehran, Iran: A 10-year retrospective study of 310 patients. Journal of Dentistry, 10, 319-328.
Slavkin, H., & Baum, B. (2000). Relationship of dental and oral pathology to systemic illness. J. Am. Med. Assoc., 284, 1215-1217. DOI: https://doi.org/10.1001/jama.284.10.1215
Matolych, U.D. (2016). Dynamika zminy intehralnykh indeksiv intoksykatsii u khvorykh na flehmony ta abstsesy shchelepno-lytsevoi dilianky [The dynamics of change of the integraled indexes of intoxication in patients with phlegmons and abscesses of the maxillofacial area. Likarska sprava – Medical Business, 1-2, 97-101 [in Ukrainian].
Cuong, Vu Viet, Avetikov, D.S., & Kravchenko, S.B. (2014). Sovremennyy vzglyad na etiologiyu i patogenez odontogennykh abtsessov i flegmon chelyustno-litsevoy oblasti [Modern view of the etiology and pathogenesis of odontogenic abscesses and phlegmon maxillofacial region]. Visnyk Problem Biolohii i Medytsyny – Bulletin of Problems Biology and Medicine, 2, (1), 79-83 [in Russian].
Pappa, H., & Jones, D.C. (2005). Mediastinitis from odontogenic infection. A case report. British Dental Journal, 198 (9), 547-548.
Kharkov, L., Yakovenko, L., & Chekhova, I. (2016). Uskladnennia likuvannia zapalnykh zakhvoriuvan tkanyn shchelepno-lytsevoi dilianky u ditei. Prychyny ta yikh profilaktyka [Complications of treatment of inflammatory diseases of tissues maxillo-facial region in children. Causes and prevention]. Sovremennaya stomatologiya – Modern Stomatology, 5, 48-52 [in Ukrainian].
Matviichuk, O.B. (2017). Biomarkery zapalennia pry tretynnomu perytoniti [Biomarkers of inflammatory in tertiary peritonitis]. Ukrainskyi zhurnal khirurhii – Ukrainian Journal of Surgery, 2 (33), 37-40 [in Ukrainian].
Huang, D.T., Yealy, D.M., & Filbin, M.R. (2018) Procalcitonin-guided use of antibiotics for lower respiratory tract infection. New England Journal of Medicine, 379 (3), 236-249. DOI: https://doi.org/10.1056/NEJMoa1802670
Haane, C., Mardin, W.A., & Irmscher, S. (2010) Procalcitonin as a marker for postoperative complications. Clinical Laboratory, 56 (3-4), 153-155.
Mehanic, S., & Baljic R. (2013). The importance of serum procalcitonin in diagnosis and treatment of serious bacterial infections and sepsis. Materia Sociomedica, 25, (4), 277-281. DOI: https://doi.org/10.5455/msm.2013.25.277-281
Norouzinia, M., Chaleshi, V., & Alizadeh, A.H.M. (2017). Biomarkers in inflammatory bowel diseases: insight into diagnosis, prognosis and treatment. Gastroenterol. Hepatol. Bed. Bench, 10, (3), 155-167.
Becker, K.L., Nylen, E.S., & White, J.C. (2004). Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors The Journal of Clinical Endocrinology & Metabolism, 89, (4), 1512-1525. DOI: https://doi.org/10.1210/jc.2002-021444
Falcao, Goncalves, Menezes, Falcao, & Duque, Pinheiro (2017). Procalcitonin as biomarker of infection: Implications for evaluation and treatment. American Journal of Therapeutics, 24, (3), 243-249. DOI: https://doi.org/10.1097/MJT.0000000000000210
Hatzistilianou, M. (2010). Diagnostic and prognostic role of procalcitonin in infections. The Scientific World Journal, 10, 1941-1946. DOI: https://doi.org/10.1100/tsw.2010.181
Bremmer, D.N. (2019). Acute exacerbations of chronic obstructive pulmonary disease with a low procalcitonin concentration: Impact of antibiotic therapy. Clin. Infect. Dis., 68, 725-729. DOI: https://doi.org/10.1093/cid/ciy552
Berezniakov, V.I., Korzh, O.M. (2015). Soderzhaniye prokaltsitonina i galektina-3 v krovi bolnykh s vnebolnichnoy pnevmoniyey s soputstvuyushchey khronicheskoy serdechnoy nedostatochnostyu i bez nee [The content of procalcitonin and galectin−3 in the blood of patients with community-acquired pneumonia and concomitant chronic heart failure and without]. Mezhdunarodnyy meditsinskiy zhurnal – International Medical Journal, 21 (4), 13-16 [in Russian].
Schuetz, P., Albrich, W., & Mueller, B. (2011). Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future. BMC Medicine, 9, 107-115. DOI: https://doi.org/10.1186/1741-7015-9-107
