Impact of autologous centrifuged shed mediastinal blood on procalcitonin, C-reactive protein levels and postoperative complications during the early period following cardiac surgery

Background

Cardiac surgery with cardiopulmonary bypass (CPB) is associated with a number of adverse effects due to systemic inflammatory response syndrome, a physiologic reaction to tissue injury. Because of this response, conventional clinical and biological signs may be misleading in the diagnosis of postoperative complications, particularly infections. The aim of the study was to evaluate the impact of autologous centrifuged shed mediastinal blood procedures in attitude of infection, estimating the predictive role of procalcitonin (PCT) and C-reactive protein (CRP) changes during the postoperative period.

Materials

We have analysed data on 90 patients, who had been subjected to cardiac surgical procedures on CPB: there are 41 patients in Group I, who were reinfused with the centrifuged autologous mediastinal blood 4 hours after the end of surgery; and 49 patients in Group II, whose shed mediastinal blood was not reinfused (control group).

Methods

We studied the quantity of haemoglobin, haematocrit and leucocyte counts, and the value of CRP and PCT concentrations before the surgery (baseline), 4 and 20 hours after the end of surgery and during 5 days after surgery. Preoperative patient conditions, intraoperative and postoperative periods, were recorded. Statistical significance was accepted at a level of P < 0.05.

Results

In Group I, patients who were reinfused with the centrifuged autologous shed mediastinal blood, requirement for the allogenic blood transfusion procedures was significantly lower (14.6% versus 38.8%, P < 0.05). The CRP concentration was greater, but there were no significant differences between the groups in all postoperative periods. At 20 hours after the end of surgery and the second postoperative day, the increase of the PCT concentration was significant and often observed in group II (33.3% versus 58.3%), where there were significantly more complications of infection (2.4% versus 10.2% P < 0.05) and a significantly longer length of postoperative hospital stay (9.32 ± 2.55 versus 14.38 ± 4.27 days, P < 0.05).

Conclusion

Our data suggest that the early reinfusion of autologous centrifugated shed mediastinal blood procedures did not increase bleeding and statistically significantly reduced the requirement of allogenic blood transfusion procedures, reduced the number of infection complications, and significantly shortened the length of postoperative hospital stay. In evaluation of postoperative infection rates, PCT is highly suggestive as a marker of postoperative complications.