title: Aprotinin reduces the procalcitonin rise associated with complex cardiac surgery and cardiopulmonary bypass.
abstract: Aprotinin, a nonspecific serine protease inhibitor, has been primarily used as a haemostatic drug in cardiac surgery with cardio-pulmonary bypass (CPB). This study investigated the effect of aprotinin on the post-operative levels of procalcitonin (PCT) and a set of cytokines in patients undergoing pulmonary artery endarterectomy (PEA). We analyzed 60 patients with chronic thromboembolic pulmonary hypertension undergoing PEA. 30 patients (Group A) were treated with aprotinin (2,00,00 IU prior anesthesia, then 2,00,00 IU in CPB prime and 50,00 IU per hour continuously); a further 30 patients (Group B) received tranexamic Acid (1 g before anesthesia, 1 g after full heparin dose and 2 g in CPB prime). PCT, TNFalpha, IL-1beta, IL-6, and IL-8 arterial concentrations were measured from before until 72 hours after surgery. Aprotinin significantly affected early post-PEA plasma PCT. Patients treated with aprotinin (Group A) had lower peak PCT levels compared to patients in Group B (1.52 ng/ml versus 2.18, p=0.024). Postoperative peak values of PCT and IL-6 correlated closely in both groups (r=0.78, r=0.83 respectively). Aprotinin attenuates the post-PEA increase of PCT in the same manner as other pro-inflammatory cytokines. Significant correlation between PCT and IL-6 post-surgery may be indicative of an indirect IL-6-mediated pathway of PCT alteration.
authors.affiliation: Institute of Pathological Physiology of the First Faculty of Medicine, Charles University, Prague, Czech Republic. maruna@lf1.cuni.cz
authors.forename: P
authors.initials: P
authors.lastname: Maruna
authors.forename: A A
authors.initials: AA
authors.lastname: Klein
authors.forename: J
authors.initials: J
authors.lastname: Kunstýř
authors.forename: K M
authors.initials: KM
authors.lastname: Plocová
authors.forename: F
authors.initials: F
authors.lastname: Mlejnský
authors.forename: J
authors.initials: J
authors.lastname: Lindner
mesh_terms: D000368:Aged; D007611:Aprotinin / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D004691:Endarterectomy; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood / Q000209:etiology / Q000601:surgery*; D018836:Inflammation Mediators / Q000097:blood; D053583:Interleukin-1beta / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008875:Middle Aged; D011498:Protein Precursors / Q000097:blood*; D011655:Pulmonary Embolism / Q000097:blood / Q000150:complications / Q000601:surgery*; D013997:Time Factors; D014148:Tranexamic Acid / Q000627:therapeutic use; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; C508606:CXCL8 protein, human; D006490:Hemostatics; C508600:IL6 protein, human; D018836:Inflammation Mediators; D053583:Interleukin-1beta; D015850:Interleukin-6; D016209:Interleukin-8; D011498:Protein Precursors; D014409:Tumor Necrosis Factor-alpha; D014148:Tranexamic Acid; D002116:Calcitonin; D007611:Aprotinin; D015740:Calcitonin Gene-Related Peptide