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Procalcitonin-Informed Decision-Making in Abdominal and Emergency Surgery: A WSES Position Paper

Catena F 1 , De Simone B 2 , Kryvoruchko IA 3 , Di Saverio S 4 , Ribeiro MAF 5 , Hardcastle TC 6 Show all authors , Işık A 7 , Ioannidis O 8 , Podda M 9 , Di Martino M 10 , Ball CG 11 , Hörer TM 12 , Ottolino P 13 , Bae JM 14 , Kim FJ 15 , Rasa K 16 , Shelat VG 17 , Navsaria P 18 , Dogjani A 19 , Tan E 20 , Dal Mas F 21 , Balogh ZJ 22 , Di Carlo I 23 , Zhang G 24 , Lee JG 25 , Weber DG 26 , Ceresoli M 27 , Bass GA 28 , Abu-Zidan FM 29 , Litvin A 30 , Costa-Navarro D 31 , Picetti E 32 , González Castillo AM 33 , Hecker A 34 , Martínez-Pérez A 35 , Ordoñez CA 36 , Gurrado A 37 , Pararas N 38 , Gomes CA 39 , Boermeester MA 40 , Fraga GP 41 , Pikoulis E 38 , Pikouli A 38 , Khan J 42 , Ferrada P 43 , Sakakushev BE 44 , Teuben MPJ 45 , Pintar Kaliterna T 46 , Doklestić Vasiljev K 47 , Ramia JM 48 , Kirkpatrick AW 49 , Inaba K 50 , Moore EE 51 , Biffl WL 52 , Malbrain MLNG 53 , Tomadze G 54 , Puyana JC 55 , Leppäniemi A 56 , Sugrue M 57 , Wani I 58 , Latifi R 59 , Kaafarani HM 60 , Stahel PF 61 , Ansaloni L 62 , Coccolini F 63 , Sartelli M 64

Affiliations 

  • 1 World Society of Emergency Surgery, Institute for Research in Emergency General Surgery (IREGS), Via Cracovia 23, 40139 Bologna, Italy
  • 2 Department of Emergency and General Minimally Invasive Surgery, Level I Trauma Center, Bufalini Hospital, AUSL Romagna, Viale Ghirotti 286, 47521 Cesena, Italy
  • 3 Department of Surgery No. 2, Kharkiv National Medical University, 61022 Kharkiv, Ukraine
  • 4 Department of General Surgery, Madonna del Soccorso Hospital, 63074 San Benedetto del Tronto, Italy
  • 5 Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
  • 6 Trauma and Burns Service, Department of Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban 4013, South Africa
  • 7 Department of General Surgery, School of Medicine, Istanbul Medeniyet University, 34700 Istanbul, Türkiye
  • 8 Fourth Department of Surgery, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
  • 9 Department of Surgical Sciences, University of Cagliari, 09042 Cagliari, Italy
  • 10 Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
  • 11 Department of Surgery, University of Calgary, Calgary, AB T2N 1N4, Canada
  • 12 Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden
  • 13 Trauma, Emergency and Abdominal Wall Unit, Hospital Dr. Sótero del Río, Av Concha y Toro 3459, Puente Alto Santiago 8150215, Chile
  • 14 Department of Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu 42415, Republic of Korea
  • 15 Department of Urology, AdventHealth Riverview, Riverview, FL 33878, USA
  • 16 Department of General Surgery, Anadolu Medical Center Hospital, 41400 Kocaeli, Türkiye
  • 17 Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
  • 18 Trauma Centre, Groote Schuur Hospital, Cape Town 7700, South Africa
  • 19 Department of Surgery, University Hospital of Trauma, 1000 Tirana, Albania
  • 20 Department of Surgery, Radboud University Medical Center, 6625 GA Nijmegen, The Netherlands
  • 21 Venice School of Management, Ca' Foscari University of Venice, 30123 Venice, Italy
  • 22 Department of Traumatology, John Hunter Hospital, Newcastle, NSW 2308, Australia
  • 23 Department of Surgical Sciences and Advanced Technologies, University of Catania, 95131 Catania, Italy
  • 24 Department of Surgery, School of Medicine, The Chinese University of Hong Kong, Shenzhen 518172, China
  • 25 Department of Surgery, Ewha Womans University College of Medicine, Ewha Womans University Mokdong Hospital, Seoul 07985, Republic of Korea
  • 26 Department of General Surgery, Royal Perth Hospital, Perth, WA 6000, Australia
  • 27 School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
  • 28 Center for Emergency Surgical Outcomes Research, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Philadelphia, PA 19104, USA
  • 29 Trauma and Emergency Research Group, Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates
  • 30 Department of Surgical Diseases No. 3, Gomel State Medical University, 246000 Gomel, Belarus
  • 31 Department of General and Digestive Surgery, Elda General University Hospital, 03600 Elda, Spain
  • 32 Department of Anesthesia and Intensive Care, Parma University Hospital, 43121 Parma, Italy
  • 33 Trauma and Emergency Surgery Unit, Department of General Surgery, Hospital del Mar, 08003 Barcelona, Spain
  • 34 Department of General and Thoracic Surgery, University Hospital of Giessen, 35392 Giessen, Germany
  • 35 Department of Surgery, University of Valencia, 46010 Valencia, Spain
  • 36 Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cali 760032, Colombia
  • 37 University Hospital of Bari, 70124 Bari, Italy
  • 38 Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, 10679 Athens, Greece
  • 39 Department of Surgery, Hospital Universitário Therezinha de Jesus, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora-SUPREMA, Juiz de Fora 36033-003, Brazil
  • 40 Department of Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
  • 41 Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas, Campinas 70124, Brazil
  • 42 University of Portsmouth, Portsmouth PO1 2UP, UK
  • 43 Department of Surgery, Inova Health, Fairfax, VA 22033, USA
  • 44 Department of Propedeutics of Surgical Diseases, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
  • 45 Department of Traumatology, University Hospital Zurich, 8091 Zürich, Switzerland
  • 46 Department of Abdominal Surgery, Division of Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
  • 47 Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
  • 48 Department of Surgery, Dr. Balmis General University Hospital, 03010 Alicante, Spain
  • 49 Departments of Surgery and Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
  • 50 Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
  • 51 Department of Surgery, Denver Health Medical Center, Denver, CO 80204, USA
  • 52 Department of Surgery, Scripps Clinic and Scripps Clinic Medical Group, San Diego, CA 92037, USA
  • 53 First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, 20059 Lublin, Poland
  • 54 Department of Surgery, Tbilisi State Medical University, 0186 Tbilisi, Georgia
  • 55 Institute of Global Surgery, School of Population Health, Royal College of Surgeons in Ireland, D02 X0N1 Dublin, Ireland
  • 56 Department of Abdominal Surgery, Helsinki University Hospital, 00290 Helsinki, Finland
  • 57 Department of Surgery, RUMC Medical School, 10450 Georgetown, Malaysia
  • 58 Department of Surgery, Government Gousia Hospital, Directorate of Health Services, Srinagar 190017, India
  • 59 Department of Surgery, Westchester Medical Center, Valhalla, NY 10595, USA
  • 60 Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
  • 61 Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA
  • 62 Department of General Surgery I, University of Pavia, 27100 Pavia, Italy
  • 63 General, Emergency and Trauma Surgery Department, Pisa University Hospital, 56100 Pisa, Italy
  • 64 Department of Surgery, Macerata Hospital, 62100 Macerata, Italy
Antibiotics (Basel), 2026 Oct 21;15(10).
PMID: 42938782 DOI: 10.3390/antibiotics15101042

Abstract

Background: Procalcitonin (PCT) may support decision-making in abdominal and emergency surgery when infection is difficult to distinguish from non-infectious inflammation. Its interpretation remains challenging because clinical settings, sampling schedules, and proposed thresholds vary. This WSES position paper examines the evidence across six clinical scenarios to provide a practical framework for PCT-informed decision-making. Methods: A structured literature review covering January 1980 to December 2025, with targeted updates through August 2026, informed six PICO-based clinical questions. Evidence appraisal drew on selected GRADE domains, including consistency, directness, and precision. Recommendations were developed through iterative expert review and consensus. Results: The panel formulated six conditional recommendations addressing intra-abdominal infection diagnosis, antibiotic discontinuation after source control, suspected source-control failure, infected pancreatic necrosis, infectious complications after trauma, and postoperative anastomotic leak. The panel's qualitative assessment rated evidence certainty as moderate for antibiotic discontinuation and the pancreatitis domain, and low for the remaining domains. Serial PCT trends may complement clinical assessment in selected patients. Evidence for reduced antibiotic exposure with predefined PCT algorithms is more established than evidence that PCT-informed imaging, reintervention, or discharge decisions improve patient outcomes. Conclusions: PCT-informed decision-making in abdominal surgery may contribute to a more individualized approach to emergency surgical care and precision emergency surgery. When interpreted as part of serial assessment and integrated with clinical judgement, organ-dysfunction trends, microbiology, imaging, and evaluation of source-control adequacy, PCT may support individualized antibiotic discontinuation, potentially earlier recognition of an unfavourable clinical course, and more timely diagnostic and source-control reassessment. Current evidence does not support universal thresholds or routine serial testing in all surgical patients. Biomarker kinetics should strengthen, but not replace, surgical reasoning or independently determine antimicrobial, imaging, or interventional decisions. Future research should validate setting-specific thresholds and sampling schedules, establish whether PCT provides actionable information before clinical deterioration, and evaluate the clinical effects and cost-effectiveness of PCT-informed pathways.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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