title: Pancreatic stone protein predicts postoperative infection in cardiac surgery patients irrespective of cardiopulmonary bypass or surgical technique.
abstract: BACKGROUND
  We investigated the role of pancreatic stone protein (PSP) in predicting the occurrence of infection in the postoperative course of cardiac surgery patients. Several biomarkers indicating the presence of inflammation and infection are available in the clinical routine; yet, their utility in the postoperative course of patients following cardiac surgery remains uncertain. Moreover, cardiopulmonary bypass, also referred to as "on-pump surgery", increases the susceptibility to an exaggerated inflammatory state. However, the impact of such extracorporeal circulation on circulating PSP levels remains poorly understood.
  
  
  METHODS
  In a prospective cohort of unselected patients undergoing cardiac surgery, we set out to elucidate the diagnostic accuracy of serum PSP levels as opposed to canonical biomarkers (CRP, WBC) of inflammation to discriminate between the presence of infection and surgical trauma,. In addition, we investigated whether the biomarkers were influenced by the surgical technique employed, i.e. on-pump vs. off-pump and minimally invasive surgery vs. sternotomy. Levels of circulating PSP and routine inflammatory biomarkers (CRP, WBC) were measured in samples taken from 120 patients at baseline as well as at postoperative day 1-3.
  
  
  RESULTS
  Univariate analysis showed that among the biomarkers investigated, only PSP levels had discriminatory power to differentiate infection from surgical trauma in the postoperative course of the entire cohort of patients following cardiac surgery. With regard to cardiac surgical interventions, there was no significant association between the absence or presence of extracorporeal circulation and PSP levels. However, there was a significant difference in the slope of the rise of postoperative PSP between minimally invasive surgery as opposed to patients subjected to sternotomy.
  
  
  CONCLUSIONS
  In an unselected population of cardiac surgery patients, post-operative serum PSP levels were significantly associated with the presence of infection in both the on-pump and off-pump setting. Of note, the surgical technique employed (sternotomy vs. minimally invasive approach) had a significant impact on postoperative PSP levels.
authors: Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors: Holger J
authors: HJ
authors: Klein
authors: Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland.
authors: Adam
authors: A
authors: Csordas
authors: Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors: Volkmar
authors: V
authors: Falk
authors: Division of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland.
authors: Ksenija
authors: K
authors: Slankamenac
authors: Division of Anesthesiology, Cardiosurgical Intensive Care Unit, University Hospital Zurich, Zurich, Switzerland.
authors: Alain
authors: A
authors: Rudiger
authors: Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors: Felix
authors: F
authors: Schönrath
authors: Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors: Hector
authors: H
authors: Rodriguez Cetina Biefer
authors: Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors: Christoph T
authors: CT
authors: Starck
authors: Division of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland.
authors: Rolf
authors: R
authors: Graf
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass; D048909:Diabetes Complications / Q000097:blood; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000150:complications / Q000473:pathology; D007958:Leukocyte Count; D051847:Lithostathine / Q000097:blood*; D008297:Male; D011183:Postoperative Complications / Q000097:blood* / Q000209:etiology*; D012372:ROC Curve; D018805:Sepsis / Q000097:blood / Q000150:complications / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D051847:Lithostathine; C497617:REG1A protein, human; D002097:C-Reactive Protein