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Effect of cardiopulmonary bypass on serum procalcitonin and C-reactive protein concentrations
1Service d'Anesthésie-Réanimation, Université Claude Bernard, Lyon, France.
Insights
Serum procalcitonin (PCT) levels rise transiently after cardiac surgery, peaking on day one. Elevated PCT above 5 ng/mL strongly indicates postoperative complications, distinguishing it from normal inflammatory responses.
Area of Science:
- Biochemistry
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Cardiac surgery, including coronary artery bypass grafting (CABG) and valvular surgery, can elicit a systemic inflammatory response.
- Biomarkers like procalcitonin (PCT) and C-reactive protein (CRP) are used to monitor postoperative inflammation and complications.
Purpose of the Study:
- To measure serum procalcitonin (PCT) concentrations following different types of cardiac surgery.
- To investigate the influence of systemic inflammatory response (SIRS) on PCT levels post-cardiac surgery.
- To establish a threshold for PCT concentration indicative of postoperative complications.
Main Methods:
- Serum PCT and CRP levels were measured in 36 patients undergoing CABG with or without cardiopulmonary bypass (CPB), and valvular surgery with CPB.
- Measurements were taken preoperatively, at the end of surgery, and daily up to postoperative day 8.
- Patients were categorized based on the presence or absence of SIRS, and a separate group with known postoperative complications was analyzed.
Main Results:
- Serum PCT concentrations showed a transient increase, peaking on postoperative day 1, irrespective of surgical type (CABG with/without CPB, valvular surgery).
- PCT levels remained below 5 ng/mL in uncomplicated cases and normalized by day 5.
- Patients with SIRS exhibited significantly higher peak PCT levels compared to those without SIRS (1.79 vs. 0.34 ng/mL).
- Patients with postoperative complications (circulatory failure, endocarditis, septic shock) had markedly elevated PCT levels, ranging from 6.2 to 230 ng/mL.
- CRP levels increased in all patients, but their elevation persisted longer than PCT.
Conclusions:
- Systemic inflammatory response (SIRS) significantly influences serum PCT concentrations after cardiac surgery.
- A postoperative serum PCT concentration exceeding 5 ng/mL is a strong indicator of a potential complication.
- PCT serves as a valuable, albeit transient, biomarker for early detection of complications following cardiac procedures.
Abstract:
We have measured serum procalcitonin (PCT) concentrations after cardiac surgery in 36 patients allocated to one of three groups: group 1, coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) (n = 12); group 2, CABG without CPB (n = 12); and group 3, valvular surgery with CPB (n = 12). Serum PCT and C-reactive protein (CRP) concentrations were measured before operation, at the end of surgery and daily until postoperative day 8. Serum PCT concentrations increased, irrespective of the type of cardiac surgery, with maximum concentrations on day 1: mean 1.3 (SD 1.8), 1.1 (1.2) and 1.4 (1.2) ng ml-1 in groups 1, 2 and 3, respectively (ns). Serum PCT concentrations remained less than 5 ng ml-1 in all patients. Concentrations returned to normal by day 5 in all groups. To determine the effect of the systemic inflammatory response (SIRS) on serum PCT concentrations, patients were divided post hoc, without considering the type of cardiac surgery, into patients with SIRS (n = 19) and those without SIRS (n = 17). The increase in serum PCT was significantly greater in SIRS (peak PCT 1.79 (1.64) ng ml-1 vs 0.34 (0.32) ng ml-1 in patients without SIRS) (P = 0.005). Samples for PCT and CRP measurements were obtained from 10 other patients with postoperative complications (circulatory failure n = 7; active endocarditis n = 2; septic shock n = 1). In these patients, serum PCT concentrations ranged from 6.2 to 230 ng ml-1. Serum CRP concentrations increased in all patients, with no differences between groups. The postoperative increase in CRP lasted longer than that of PCT. We conclude that SIRS induced by cardiac surgery, with and without CPB, influenced serum PCT concentrations with a moderate and transient postoperative peak on the first day after operation. A postoperative serum PCT concentration of more than 5 ng ml-1 is highly suggestive of a postoperative complication.