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

@article{catena2026procalcitonininformed,
  title = {{Procalcitonin-Informed Decision-Making in Abdominal and Emergency Surgery: A WSES Position Paper.}},
  author = {Fausto Catena and Belinda De Simone and Igor A Kryvoruchko and Salomone Di Saverio and Marcelo A F Ribeiro and Timothy Craig Hardcastle and Arda Işık and Orestis Ioannidis and Mauro Podda and Marcello Di Martino and Chad G Ball and Tal M Hörer and Pablo Ottolino and Jung-Min Bae and Fernando J Kim and Kemal Rasa and Vishal G Shelat and Pradeep Navsaria and Agron Dogjani and Edward Tan and Francesca Dal Mas and Zsolt J Balogh and Isidoro Di Carlo and Guixi Zhang and Jae Gil Lee and Dieter G Weber and Marco Ceresoli and Gary Alan Bass and Fikri M Abu-Zidan and Andrey Litvin and David Costa-Navarro and Edoardo Picetti and Ana María González Castillo and Andreas Hecker and Aleix Martínez-Pérez and Carlos A Ordoñez and Angela Gurrado and Nikolaos Pararas and Carlos Augusto Gomes and Marja A Boermeester and Gustavo P Fraga and Emmanouil Pikoulis and Anastasia Pikouli and Jim Khan and Paula Ferrada and Boris E Sakakushev and Michel P J Teuben and Tadeja Pintar Kaliterna and Krstina Doklestić Vasiljev and José Manuel Ramia and Andrew W Kirkpatrick and Kenji Inaba and Ernest E Moore and Walter L Biffl and Manu L N G Malbrain and Gia Tomadze and Juan Carlos Puyana and Ari Leppäniemi and Michael Sugrue and Imtiaz Wani},
  journal = {Antibiotics (Basel, Switzerland)},
  year = {2026},
  month = oct,
  doi = {10.3390/antibiotics15101042},
  url = {https://europepmc.org/article/MED/42938782},
  note = {CC BY},
}

TY  - JOUR
TI  - Procalcitonin-Informed Decision-Making in Abdominal and Emergency Surgery: A WSES Position Paper.
AU  - Fausto Catena
AU  - Belinda De Simone
AU  - Igor A Kryvoruchko
AU  - Salomone Di Saverio
AU  - Marcelo A F Ribeiro
AU  - Timothy Craig Hardcastle
AU  - Arda Işık
AU  - Orestis Ioannidis
AU  - Mauro Podda
AU  - Marcello Di Martino
AU  - Chad G Ball
AU  - Tal M Hörer
AU  - Pablo Ottolino
AU  - Jung-Min Bae
AU  - Fernando J Kim
AU  - Kemal Rasa
AU  - Vishal G Shelat
AU  - Pradeep Navsaria
AU  - Agron Dogjani
AU  - Edward Tan
AU  - Francesca Dal Mas
AU  - Zsolt J Balogh
AU  - Isidoro Di Carlo
AU  - Guixi Zhang
AU  - Jae Gil Lee
AU  - Dieter G Weber
AU  - Marco Ceresoli
AU  - Gary Alan Bass
AU  - Fikri M Abu-Zidan
AU  - Andrey Litvin
AU  - David Costa-Navarro
AU  - Edoardo Picetti
AU  - Ana María González Castillo
AU  - Andreas Hecker
AU  - Aleix Martínez-Pérez
AU  - Carlos A Ordoñez
AU  - Angela Gurrado
AU  - Nikolaos Pararas
AU  - Carlos Augusto Gomes
AU  - Marja A Boermeester
AU  - Gustavo P Fraga
AU  - Emmanouil Pikoulis
AU  - Anastasia Pikouli
AU  - Jim Khan
AU  - Paula Ferrada
AU  - Boris E Sakakushev
AU  - Michel P J Teuben
AU  - Tadeja Pintar Kaliterna
AU  - Krstina Doklestić Vasiljev
AU  - José Manuel Ramia
AU  - Andrew W Kirkpatrick
AU  - Kenji Inaba
AU  - Ernest E Moore
AU  - Walter L Biffl
AU  - Manu L N G Malbrain
AU  - Gia Tomadze
AU  - Juan Carlos Puyana
AU  - Ari Leppäniemi
AU  - Michael Sugrue
AU  - Imtiaz Wani
PY  - 2026
DA  - 2026/10/21
JO  - Antibiotics (Basel, Switzerland)
DO  - 10.3390/antibiotics15101042
UR  - https://europepmc.org/article/MED/42938782
AB  - 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.
SN  - 2079-6382
ER  -