Procalcitonin-Informed Decision-Making in Abdominal and Emergency Surgery: A WSES Position Paper
Year: 2026
Type: review
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.
Source: Antibiotics
Authors: Fausto Catena, Belinda De Simone, Igor A. Kryvoruchko, Salomone Di Saverio, Marcelo A. F. Ribeiro, Timothy Craig Hardcastle, Arda Işık, Orestis Ioannidis, Mauro Podda, Marcello Di Martino, Chad G. Ball, Tal M. Hörer, Pablo Ottolino, Jung-Min Bae, Fernando J. Kim, Kemal Rasa, Vishal G. Shelat, Pradeep Navsaria, Agron Dogjani, Edward Tan, Francesca Dal Mas, Zsolt J. Balogh, Isidoro Di Carlo, Guixi Zhang, Jae Gil Lee, Dieter G. Weber, Marco Ceresoli, Gary Alan Bass, Fikri M. Abu-Zidan, Andrey Litvin, David Costa-Navarro, Edoardo Picetti, Ana María González Castillo, Andreas Hecker, Aleix Martínez-Pérez, Carlos A. Ordoñez, Angela Gurrado, Nikolaos Pararas, Carlos Augusto Gomes, Marja A. Boermeester, Gustavo P. Fraga, Emmanouil Pikoulis, Anastasia Pikouli, Jim Khan, Paula Ferrada, Boris E. Sakakushev, Michel P. J. Teuben, Tadeja Pintar Kaliterna, Krstina Doklestić Vasiljev, José Manuel Ramia, Andrew W Kirkpatrick, Kenji Inaba, Ernest E. Moore, Walter L. Biffl, Manu L. N. G. Malbrain, Gia Tomadze, Juan Carlos Puyana, Ari Leppäniemi, Michael Sugrue, Imtiaz Wani, Rifat Latifi, Haytham M. Kaafarani, Philip F. Stahel, Luca Ansaloni, Federico Coccolini, Massimo Sartelli
Institutions: Università degli Studi eCampus, Ospedale “M. Bufalini” di Cesena, Kharkiv National Medical University, University of Maryland, Baltimore, University of KwaZulu-Natal, Istanbul Medeniyet University, Aristotle University of Thessaloniki, G. Papanikolaou General Hospital, University of Cagliari, Università degli Studi del Piemonte Orientale “Amedeo Avogadro”, Azienda Ospedaliero Universitaria Maggiore della Carita, University of Calgary, Foothills Medical Centre, Örebro University, Complejo Asistencial Sótero del Río, Yeungnam University Medical Center, Yeungnam University College, AdventHealth, Tan Tock Seng Hospital, University of Cape Town, Groote Schuur Hospital, University of Medicine Tirana, Radboud University Medical Center, Ca' Foscari University of Venice, John Hunter Hospital, University of Newcastle Australia, University of Catania, Ospedale Cannizzaro, Chinese University of Hong Kong, Chinese University of Hong Kong, Shenzhen, Ewha Womans University, Ewha Womans University Mokdong Hospital, The University of Western Australia, Curtin University, Royal Perth Hospital, University of Milano-Bicocca, University of Pennsylvania, United Arab Emirates University, Gomel State Medical University, Hospital General de Elda, Ospedale di Parma, Hospital Del Mar, Universitätsklinikum Gießen und Marburg, Universitat de València, Fundación Valle del Lili, Universidad Icesi, Universidad del Valle, University of Bari Aldo Moro, National and Kapodistrian University of Athens, University General Hospital Attikon, Universidade Federal de Juiz de Fora, Amsterdam University Medical Centers, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Universidade Estadual de Campinas (UNICAMP), Portsmouth Hospitals NHS Trust, University of Portsmouth, Inova Health System, Medical University Plovdiv, University Hospital Zurich, Ljubljana University Medical Centre, University of Belgrade, Univerzitetski Klinički Centar Srbije, Universitat de Miguel Hernández d'Elx, Hospital General Universitario de Alicante Doctor Balmis, University of Southern California, Denver Health Medical Center, University of Colorado Anschutz, University of Colorado Denver, Scripps Health, Scripps Clinic Medical Group, Scripps Clinic, Medical University of Lublin, Tbilisi State Medical University, Royal College of Surgeons in Ireland, University of Helsinki, Helsinki University Hospital, RCSI & UCD Malaysia Campus, Westchester Medical Center, New York Medical College, Harvard University, Massachusetts General Hospital, Rocky Vista University, Mission Health, East Carolina University, University of Pavia, Policlinico San Matteo Fondazione, Azienda Ospedaliera Universitaria Pisana, Ospedale di Macerata
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,499
OpenAlex ID: W7223174311