title: Procalcitonin level for prediction of postoperative infection in cardiac surgery.
abstract: BACKGROUND
  Diagnosing infection after cardiac surgery remains difficult due to the systemic inflammatory response induced by cardiopulmonary bypass. We compared procalcitonin levels with white blood cell counts as predictors of infection after cardiac surgery.
  
  
  METHODS
  We prospectively enrolled 100 consecutive adult cardiac patients. Postoperative white blood cell counts, serum procalcitonin levels, and blood cultures were examined.
  
  
  RESULTS
  The sensitivity and specificity of white blood cell count and procalcitonin > 2 ng mL(-1) were 60% and 100%, 58.8% and 42.5%, respectively. Procalcitonin > 7 ng mL(-1) had 95% sensitivity and 80% specificity. Receiver-operating characteristic analysis showed a greater area under the curve for procalcitonin level (p < 0.0001) compared to white blood cell count (p = 0.31). Patients with positive blood cultures had significantly higher procalcitonin levels (51.97 ± 39.62 vs. 6.67 ± 10.73 ng mL(-1)), Acute Physiology and Chronic Health Evaluation-II scores (16.95 ± 3.24 vs. 13.60 ± 2.98), and intensive care unit stay (6.35 ± 3.42 vs. 4.6 ± 2.2 days). Non-survivors had significantly higher Acute Physiology and Chronic Health Evaluation-II scores (19.09 ± 1.30 vs. 13.67 ± 2.97) and procalcitonin levels (43.83 ± 52.15 vs. 12.26 ± 19.89 ng mL(-1)) but on logistic regression analysis, only Acute Physiology and Chronic Health Evaluation-II score was an independent risk factor for mortality.
  
  
  CONCLUSIONS
  The diagnostic accuracy of procalcitonin for bacterial infection is fairly high. Acute Physiology and Chronic Health Evaluation-II score is a better predictor of mortality and morbidity than absolute procalcitonin level. Procalcitonin > 7 ng mL(-1) can prognosticate and identify the high-risk group.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, U N Mehta Institute of Cardiology and Research Center, Asarwa, Ahmedabad, Gujarat, India realpranav@yahoo.com.
authors.forename: Pranav
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, U N Mehta Institute of Cardiology and Research Center, Asarwa, Ahmedabad, Gujarat, India.
authors.forename: Kartik
authors.initials: K
authors.lastname: Patel
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, U N Mehta Institute of Cardiology and Research Center, Asarwa, Ahmedabad, Gujarat, India.
authors.forename: Kinnaresh
authors.initials: K
authors.lastname: Baria
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, U N Mehta Institute of Cardiology and Research Center, Asarwa, Ahmedabad, Gujarat, India.
authors.forename: Ketav
authors.initials: K
authors.lastname: Lakhia
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, U N Mehta Institute of Cardiology and Research Center, Asarwa, Ahmedabad, Gujarat, India.
authors.forename: Amber
authors.initials: A
authors.lastname: Malhotra
authors.affiliation: Department of Research, U N Mehta Institute of Cardiology and Research Center, Asarwa, Ahmedabad, Gujarat, India.
authors.forename: Komal
authors.initials: K
authors.lastname: Shah
authors.affiliation: Department of Research, U N Mehta Institute of Cardiology and Research Center, Asarwa, Ahmedabad, Gujarat, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Patel
mesh_terms: D018806:APACHE; D000328:Adult; D019540:Area Under Curve; D001424:Bacterial Infections / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002116:Calcitonin
keywords: Biomarkers; Cardiac surgical procedures; Cardiopulmonary bypass; Leukocyte count; Procalcitonin; Sepsis