The prognostic value of procalcitonin in cardiac surgical patients

Introduction

The aim of this prospective study was to determine the prognostic value of serum levels of procalcitonin (PCT) in patients early after cardiac surgery using cardiopulmonary bypass (CPB). We studied whether PCT is useful as an early prognostic marker in cardiosurgical patients with respect to complications and infections and whether PCT is a specific marker for the occurrence of infections.

Methods

We studied 74 patients (mean ± standard deviation age, 65 ± 9) after elective cardiac surgery and daily until the second postoperative day. Demographic data, operative data and clinical endpoints (SIRS, infection and severe complication) were documented. Complications were defined as circulatory failure, respiratory failure, renal dysfunction, hepatic dysfunction, and coagulation dysfunction.

Results

SIRS occurred in 46 patients (62%), infection in four patients (5.4%) and non-infectious complication in 35 patients (47.2%). Circulatory failure occurred in 29 patients, respiratory failure in 19 patients, renal failure in two patients, hepatic dysfunction in six patients, coagulation dysfunction in eight patients. Serum PCT concentrations increased in all patients with peak levels occurring on the first postoperative day (PCT1: 0.495 standard error of the mean [SEM] 0.068, PCT2: 2.62 SEM 0.42, PCT3: 1.65 SEM 0.23). The serum PCT levels were increased in patients with SIRS compared with patients with no-SIRS. Using the Mann–Whitney U test we found a statistically significant increase on PCT levels in patients with infection (P = 0.001) and in patients with non-infectious complications (P = 0.005). PCT was not significantly different in patients with infectious complications in comparison with patients with non-infectious complications. There was good correlation (Pearson correlation) between PCT level and CPB duration, duration of aortic clamping and EURO score.

Conclusion

PCT is a valuable prognostic marker early after cardiac surgery using CPB with respect to infection and severe complications. However, PCT does not differentiate infectious and non-infectious complications.