Diagnostic value of procalcitonin monitoring in cardiac surgery

Objective

To study the diagnostic value of procalcitonin (PCT) monitoring in adult high-risk patients who underwent valvular surgery.

Methods

Sixty high-risk patients (mean age 51 ± 11 years) with two or more risk factors (severe initial condition, proinflammatory diseases in anamnesis, repeated operations, expected cardiopulmonary bypass [CPB] time > 2 hours, age > 60 years, preceding hospitalization and antibacterial therapy) were enrolled into the study. Besides routine clinical investigations, which were performed daily, blood plasma samples were collected before and at 1, 2, 3 and 6 days after surgery. PCT values were determined using the immunoluminometric assay (LUMItest^® PCT, BRAHMS Aktiengesellschaft, Germany). All patients were divided into two groups: Group A without and Group B with postoperative infectious complications. All data were compared by t test and P < 0.05 was considered statistically significant.

Results

There was no difference in age, CPB and aorta cross-clamping time between the groups. Initial PCT concentrations did not exceed normal values (<0.5 ng/ml). Postoperatively, 14/60 (23.3%) patients developed infectious complications (10 pneumonia, one surgical site infection [SSI], one pneumonia and SSI, one sepsis, one pneumonia and sepsis). The ICU and hospital stay after surgery were significantly longer in Group B compared with Group A (5.1 and 23.9 days vs 2.2 and 17.1 days, respectively, P < 0.05). PCT levels were significantly higher in patients with infection during all the observation period, while the difference between the groups in APACHE II score appeared only from the second day postoperatively. The data are presented in Table 1.

Table 1

Conclusions

PCT levels are higher and remain increased for longer in patients with postoperative infection. PCT monitoring is useful for early diagnostics and prediction of severe postoperatice infections in cardiac surgery.