Sternotomy infection: poor prediction by acute phase response and delayed hypersensitivity

Area of Science:

• Cardiovascular Surgery
• Infectious Disease
• Immunology

Background:

• Sternal wound infection is a serious complication following cardiac surgery.
• Identifying high-risk patients preoperatively is crucial for targeted prevention strategies.

Purpose of the Study:

• To evaluate the predictive value of nutritional status, acute phase protein response, and delayed hypersensitivity for sternal wound infection risk.
• To identify clinical factors correlating with sternal wound infection development.

Main Methods:

• Prospective study of 221 adult cardiac surgical patients.
• Assessment of nutritional proteins (retinol-binding protein, prealbumin, transferrin), acute phase proteins (C-reactive protein, alpha 1-acid glycoprotein, complements B and C3), and delayed hypersensitivity.
• Stepwise logistic regression analysis to identify risk factors.

Main Results:

• No significant correlation found between preoperative nutritional status or acute phase protein levels and sternal infection.
• Elevated preoperative complement C3 (80%) and postoperative alpha 1-acid glycoprotein (80%) were observed in patients who developed sternal infections.
• Age, body weight, preoperative ICU stay, repeat sternotomy, internal mammary artery grafting, postoperative hemorrhage, and cardiac arrest were significant predictors of sternal infection.

Conclusions:

• Routine delayed hypersensitivity testing is not valuable for predicting sternal infection risk in cardiac surgery patients.
• Preoperative complement C3 and postoperative alpha 1-acid glycoprotein may warrant further investigation as potential predictive markers.
• A logistic regression model incorporating clinical factors can predict sternal wound infection risk.