Prognostic value of procalcitonin in patients after elective cardiac surgery: a prospective cohort study
Klingele et al. Ann. Intensive Care
Prognostic value of procalcitonin in patients after elective cardiac surgery: a prospective cohort study
Matthias Klingele 1 2
Hagen Bomberg 0
Simone Schuster 3
HansJ‑oachim Schäfers 3
Heinrich Volker Groesdonk 0
0 Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, University of Saarland , Kirrbergerstrasse, 66421 Homburg/Saar , Germany
1 Department of Medicine , Hochtaunuskliniken, Usingen , Germany
2 Division of Nephrology and Hypertension, Department of Medicine, Saarland University Medical Center, University of Saarland , Homburg/Saar , Germany
3 Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, University of Saarland , Homburg/ Saar , Germany
Background: Procalcitonin (PCT) is a well‑ known prognostic marker after elective cardiac surgery. However, the impact of elevated PCT in patients with an initially uneventful postoperative course is still unclear. The aim of this study was to evaluate PCT levels as a prognostic tool for delayed complications after elective cardiac surgery. Methods: A prospective study was performed in 751 patients with an apparently uneventful postoperative course within the first 24 h after elective cardiac surgery. Serum PCT concentration was taken the morning after surgery. All patients were screened for the occurrence of delayed complications. Delayed complications were defined by inhospital death, intensive care unit readmission, or prolonged length of hospital stay (>12 days). Odds ratios (OR) [with 95% confidence interval (CI)] were calculated by logistic regression analyses and adjusted for confounders. Predictive capacity of PCT for delayed complications was calculated by ROC analyses. The cutoff value of PCT was derived from the Youden Index calculation. Results: Among 751 patients with an initially uneventful postoperative course, 117 patients developed delayed complications. Serum PCT levels the first postoperative day were significantly higher in these 117 patients (8.9 ng/ml) compared to the remaining 634 (0.9 ng/ml; p < 0.001). ROC analyses showed that PCT had a high accuracy to predict delayed complications (optimal cutoff value of 2.95 ng/ml, AUC of 0.90, sensitivity 73% and specificity 97%). Patients with PCT levels above 2.95 ng/ml the first postoperative day had a highly increased risk of delayed complications (adjusted OR, 110.2; 95% CI 51.5-235.5; p < 0.001). Conclusions: A single measurement of PCT seems to be a useful tool to identify patients at risk of delayed complications despite an initially uneventful postoperative course.
Cardiac surgery; Procalcitonin; Risk factor; Delayed complications
-
Background
Procalcitonin (PCT) is a well-known marker after
elective cardiac surgery [1–7]. It is a 116-amino acid peptide
secreted from thyroid parafollicular cells as the precursor
of calcitonin [8]. Regarding inflammatory response, PCT
is synthesized in nearly all organs like liver, lung,
kidney, intestine and almost all other tissues throughout the
body [9, 10]. The production of PCT can be induced by
endotoxin of gram-negative bacteria or by
proinflammatory cytokines (e.g., IL-1 and IL-6 or TNF-α) [8].
High serum PCT has been described in patients with
systemic infection [11], strongly correlating with the
extent and severity of bacterial infections and in case of
systemic inflammatory response [12, 13].
The use of cardiopulmonary bypass leads to various
degrees of a systemic inflammatory response syndrome
associated with an increase of PCT levels within the first
24 h postoperatively [7, 13, 14]. Cardiac patients with
increased serum levels of PCT have been found to be
© The Author(s) 2016. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License
(http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium,
provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.
related to the development of complications after surgery
[1–7, 15]. However, these studies were not focused on
patients with an initially uneventful postoperative course.
If the initially postoperative course was uneventful, the
elevated PCT levels were not included in the
decisionmaking process for further therapy concepts. This was
due to the fact that the predictive value of elevated PCT
levels on the first postoperative in patients with initially
uneventful postoperative course is still unknown.
However, if these patients developed delayed complications
with the need for ICU readmission, an extension of
hospital stay with worse outcome was expected [16, 17].
In this prospective cohort study, we analyzed the
predictive power of a single serum procalcitonin
measurement in identifying patients after elective cardiac surgery
at risk of delayed co (...truncated)