Use of procalcitonin for identification of postoperative complications after coronary artery bypass surgery with cardiopulmonary bypass

Introduction

The values of C-reactive protein (CRP) and procalcitonin (PCT) were investigated to determine their effects on postoperative complications in patients with or without systemic inflammatory response syndrome (SIRS).

Methods

In 183 patients, in a prospective observational study, serum CRP and PCT values were collected every day starting on postoperative day 1 through day 5. The definition of SIRS includes two or more of the following: temperature >38 or <36°C; heart rate >90 beats/minute; respiratory rate >20/minute; arterial carbon dioxide pressure <32 mmHg; white blood cell count >12,000/mm³ and <4.00/mm³. The ability of PCT to predict sepsis and other postoperative complications were determined by performing receiver operative characteristic curve analysis.

Results

All patients were divided post hoc into patients with SIRS (Group 1, n = 83) and patients without SIRS (Group 2, n = 100). A PCT threshold value of 2.79 ng/ml on postoperative day 1 was able to discriminate postoperative complications in patients with or without SIRS with a sensitivity of 82.5% and a specificity of 70% (area under curve: 0.76, P < 0.01).

Conclusion

(1) Serum PCT values increased significantly after cardiopulmonary bypass in the SIRS group in comparison with patients without SIRS on postoperative day 1 and remain elevated until postoperative day 5. (2) Serum CRP values also follow a similar pattern, buta CRP threshold value was not obtained to differentiate between postoperative complications in patients with or without SIRS. A PCT threshold value of 2.79 ng/ml on postoperative day 1 is a valuable marker to discriminate between patients with or without SIRS.