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Hyperprocalcitonemia in patients with perioperative myocardial infarction after cardiac surgery
J B Lecharny1, D Khater, R Bronchard
1Service d'Anesthésiologie et Réanimation Chirurgicale, Hôpital Bichat-Claude Bernard, Paris, France.
Insights
Elevated procalcitonin (PCT) levels after cardiac surgery may indicate perioperative myocardial infarction (PMI), not infection. Caution is advised when interpreting high PCT concentrations in the early postoperative period for diagnosing infection.
Area of Science:
- Biochemistry
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Procalcitonin (PCT) is a biomarker often used to diagnose bacterial infections.
- Cardiac surgery can lead to physiological changes that might affect PCT levels.
- Differentiating infection from other postoperative complications is crucial for appropriate patient management.
Purpose of the Study:
- To compare procalcitonin (PCT) concentrations in patients undergoing cardiac surgery with and without perioperative myocardial infarction (PMI).
- To evaluate the utility of PCT as an early indicator of PMI versus infection post-cardiac surgery.
Main Methods:
- A retrospective comparative study was conducted at a university hospital.
- Fifty-eight adult patients undergoing cardiac surgery were analyzed.
- Plasma PCT levels were measured preoperatively and up to 72 hours postoperatively, with a specific focus on day one for comparison between PMI and uncomplicated groups.
Main Results:
- In uncomplicated cases, PCT peaked at 24 hours post-cardiac surgery (1.14 +/- 1.24 ng/mL).
- Patients with perioperative myocardial infarction (PMI) exhibited significantly higher PCT concentrations on postoperative day one (27.1 +/- 63.2 ng/mL) compared to uncomplicated patients (2.0 +/- 2.4 ng/mL).
- All patients included in the comparative analysis were confirmed to be free from infection.
Conclusions:
- High plasma PCT concentrations were observed in patients with PMI following cardiac surgery.
- Elevated PCT levels in the early postoperative period after cardiac surgery should be interpreted cautiously for infection diagnosis.
- PCT may serve as a potential early marker for PMI, necessitating careful consideration alongside other clinical and biochemical data.
Objective:
To describe and compare procalcitonin (PCT) concentrations after cardiac surgery in uncomplicated patients and in patients with perioperative myocardial infarction (PMI).
Design:
Retrospective comparative study.
Setting:
One university hospital.
Patients:
Fifty-eight adult patients undergoing cardiac surgery.
Intervention:
None.
Measurements And Main Results:
In a first step, plasma PCT and C-reactive protein concentrations were measured preoperatively and until 72 hrs postoperatively in ten consecutive patients who underwent uncomplicated cardiac surgery. PCT concentrations increased progressively from the end of cardiopulmonary bypass (0.09 +/- 0.09 ng/mL), peaked at 24 hrs postoperatively (1.14 +/- 1.24 ng/mL), and began to decrease at 48 hrs. C-reactive protein appeared to peak at 48 hrs (from 5.8 +/- 11.7 mg/L preoperatively to 265.1 +/- 103.5 mg/L on the second postoperative day). In a second step, PCT concentrations were measured at day one in 23 patients (PMI group) who presented high postoperative plasma cardiac troponin I concentrations and were compared with PCT concentrations observed in 25 matched uncomplicated patients. All patients were free from infection. PCT in the PMI group was significantly higher than in the control group (27.1 +/- 63.2 vs. 2.0 +/- 2.4 ng/mL, respectively; p =.0053).
Conclusion:
Because high plasma concentrations of PCT were found in patients with PMI after cardiac surgery, it may be suggested that, in the early postoperative period, elevated plasma PCT concentrations should be interpreted with caution regarding infection diagnosis.