Early increase of procalcitonin after cardiovascular surgery in patients with postoperative complications.
OBJECTIVE
Type and frequency of postoperative abnormalities were registered after cardiovascular surgery to evaluate the aetiology and diagnostic value of increased concentrations of procalcitonin (PCT) and C-reactive protein (CRP) during the early postoperative period.


METHODS
Prospective, observational study.


METHODS
Two hundred and eight patients undergoing coronary artery bypass grafting or valve replacement requiring cardiopulmonary bypass were monitored for 7 days postoperatively for various types of infectious or non-infectious complications. Plasma PCT and CRP levels were measured on day 1 and day 2 after surgery and, when increased, until day 7.


RESULTS
More patients with PCT above 2 ng/ml on day 1 or 2 (n=55) had postoperative abnormalities (95%) than patients with lower PCT (59%). Specifically, the incidence of three or more criteria of the "systemic inflammatory response syndrome" was 45% versus 4% (area under the curve of the receiver operating characteristic 0.866); positive inotropic support was needed in 65% versus 9% (0.870); respiratory insufficiency (PaO(2)/FIO(2)<200) 38% versus 12% (0.704); proven and suspected bacterial infection 9% versus 1% (0.900) and 24% versus 1% (0.897), respectively. For CRP, the respective areas under the curve were all below 0.63, while all patients had elevated CRP levels, whether they had a complication or not.


CONCLUSIONS
Elevated PCT, but not CRP, correlates with evidence of systemic inflammation and other complications early postoperatively after cardiac surgery. Although the PCT levels do not rise as quickly as the criteria of the systemic inflammatory response syndrome appear, they do reflect systemic inflammation. Early identification and quantification of a systemic inflammatory response may help reduce postoperative complications.
Department of Anaesthesiology and Intensive Care Medicine, Friedrich-Schiller-Universität Jena, Bachstrasse 18, 07743 Jena, Germany. michael.meisner@t-online.de
M
M
Meisner
C
C
Rauschmayer
J
J
Schmidt
R
R
Feyrer
R
R
Cesnjevar
D
D
Bredle
K
K
Tschaikowsky
D018806:APACHE; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000097:blood / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000097:blood*; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D018805:Sepsis; D018746:Systemic Inflammatory Response Syndrome
C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide