Procalcitonin is useful whereas C-reactive protein is not,to predict complications following coronary artery bypass surgery

Abstract

Background: The respective value of procalcitonin (PCT) and C-reactive protein (CRP) as markers of postoperative complications after coronary bypass surgery is unclear. Therefore, complications during one week after surgery were studied to evaluate the predictive role of PCT and CRP changes during the immediate postoperative period.

Methods: Thirty-two patients, in whom an uneventful immediate postoperative course was anticipated, were prospectively enrolled and followed-up to the 7th postoperative day. At the end of the follow-up, patients were divided into two groups. Group A were patients with an uncomplicated postoperative course and Group B were patients with a complicated postoperative course.

Results: Serum samples were drawn for PCT and CRP determination after induction of anesthesia (baseline), at the end of surgery and daily until postoperative day 2. Baseline serum PCT concentrations were 0.119 ± 0.09 and 0.209 ± 0.21 ng/mL in Groups A and B, respectively (NS). Serum PCT concentration increased compared with baseline in both groups during the first two days after surgery. The increase in serum PCT concentration was significantly greater in Group B than A patients (p<0.0002). Considering a perioperative abnormal cut-off value of > 0.5 ng/mL, there were none in Group A versus 57% in Group B (p<0.0001). Baseline serum CRP concentrations were 1.449 ± 1.30 and 1.589 ± 1.35 ng/mL in Groups A and B, respectively (NS). After surgery, CRP increased significantly compared with baseline in both groups. When changes in time-varying variables were included in a logistic model, complications were predicted by changes (between baseline and end of surgery values) of PCT (coefficient=9.410; t=2.18) and heart rate (coefficient=0.075; t=1.57), whereas changes of CRP, white blood cells, mean blood and central venous pressures did not contribute statistically. The model constant was -4.827 (t= -2.43) and the ROC curve area was 0.8971. Thus, absolute PCT changes of 0.20, 0.40 and 0.60 ng/mL carry an approximate risk of 5, 26 and 69%, respectively, of postoperative complications in the time frame of this study.

Conclusions: A postoperative serum PCT concentration of >0.5 ng/mL is highly suggestive of a postoperative complication. CRP changes do not contribute to predictive information.

Get full access to this article

View all access options for this article.

References

Wan S , LeClerc JL , Vincent JL. Inflammatory response to cardiopulmonary bypass. Mechanisms involved and possible therapeutic strategies . Chest 1997; 112: 676-692 .

Hill GE , Whitten CW , Landers D. The influence of cardiopulmonary bypass on cytokines and cell-cell communication . J Cardiothorac Vasc Anesth 1997; 11: 367-375 .

Meisner M. Procalcitonin: a new, innovative infection parameter, third edition. Stuttgart New York: Thieme , 2000. ISBN 3-13-105503-0.

Mimoz O , Benoist JF , Edouard AR , Assicot M , Bohoun C , Samii K. Procalcitonin and C-reactive protein during the early post-traumatic systemic inflammatory response syndrome . Intensive Care Med 1998; 24: 185-188 .

Carsin H , Assicot M , Feger F et al. Evolution and significance of circulating procalcitonin compared with IL-6, TNF alpha and endotoxin levels early after thermal injury . Burns 1997; 23: 218-224 .

Nylen ES , Al Arifi A , Becker KL , Snider RH Jr , Alzeer A. Effect of classic headstroke on serum procalcitonin . Crit Care Med 1997; 25: 1362-1365 .

Meisner M , Tschaikowsky K , Hutzler A , Schick C , Schuttler J. Postoperative plasma concentration of procalcitonin after different types of surgery . Intensive Care Med 1998; 24: 680-684 .

Meisner M , Rauschmayer C , Schmidt J et al. Early increase of procalcitonin after cardiovascular surgery in patients with postoperative complications . Intensive Care Med 2002; 28: 1094-1102 .

Hensel M , Volk T , Docke WD et al. Hyperprocalcitoninemia in patients with non infectious SIRS and pulmonary dysfunction associated with cardiopulmonary bypass . Anesthesiology 1998; 89: 93-104 .

10.

Adamik B , Kubler-Kielb J , Golebiowska B , Gaminan A , Kubler A. Effect of sepsis and cardiac surgery with cardiopulmonary bypass on plasma level of nitric oxide metabolites, neopterin and procalcitonin: correlation with mortality and postoperative complications . Intensive Care Med 2000; 26: 1259-1267 .

11.

Aouifi A , Piriou V , Bastien O et al. Usefulness of procalcitonin for diagnosis of infection in cardiac surgical patients . Crit Care Med 2000; 28: 3171-3176 .

12.

Boeken U , Feindt P , Micek M , Petzold T , Schulte HD , Gams E. Procalcitonin (PCT) in cardiac surgery: diagnostic value in systemic inflammatory response syndrome (SIRS), sepsis and after heart transplantation (HTX) . Cardiovasc Surg 2000; 8: 550-554 .

13.

Sablotzki A , Friedrich I , Muhling J et al. The systemic inflammatory response syndrome following cardiac surgery: different expression of proinflammatory cytokines and procalcitonin in patients with and without multiorgan dysfunction . Perfusion 2002; 17: 103-109 .

14.

Dorge H , Schondube FA , Dorge P , Seipelt R , Voss M , Messmer BJ. Procalcitonin is a valuable prognostic marker in cardiac surgery but not specific for infection . Thorac Cardiovasc Surg 2003; 51: 322-326 .

15.

Sablotzki A , Dehne MG , Friedrich I et al. Different expression of cytokines in survivors and non-survivors from MODS following cardiovascular surgery . Eur J Med Res 2003; 8: 71-76 .

16.

Arkader R , Troster EJ , Abellan DM et al. Procalcitonin and C-reactive protein kinetics in postoperative pediatric cardiac surgical patients . J Cardiothorac Vasc Anesth 2004; 18: 160-165 .

17.

Ghillani PP , Motte P , Troalen F et al. Identification and measurement of calcitonin precursor in serum of patients with malignant diseases . Cancer Res 1989; 49: 6845-6851 .

18.

Assicot M , Gendrel D , Carsin H , Raymond J , Guilbaud J , Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection . Lancet 1993; 341: 515-518 .

19.

Al Nawas B , Krammer I , Shah PM. Procalcitonin in diagnosis of severe infections . Eur J Med Res 1996; 1: 331-333 .

20.

Dandona P , Nix D , Wilson MF et al. Procalcitonin increase after endotoxin injection in normal subjects . J Clin Endocrinol Metab 1994; 79: 1605-1608 .

21.

Gendrel D , Assicot M , Raymond J , Moulin F , Francoual C , Badoual J. Procalcitonin as a marker for the early diagnosis of neonatal infection . J Pediatr 1996; 128: 570-573 .

22.

Bensousan TA , Vincent F , Assicot M et al. Monokines, procalcitonin and opiod peptides course during a model of SIRS . Shock 1997; 8 (suppl): 47-48 .

23.

Nylen ES , Whang KT , Snider RH , Steinwald PM , White JC , Becker KL. Mortality is increased by procalcitonin and decreased by an antiserum reactive to procalcitonin in experimental sepsis . Crit Care Med 1998; 26: 1001-1006 .

24.

Aouifi A , Piriou V , Blanc P et al. Effect of cardiopulmonary bypass on serum procalcitonin and C-reactive protein concentration . Br J Anaesth 1999; 83: 602-607 .

25.

Boralesa H , De Beer FC , Manchie A , Whitham JG , Pepys MB. C-reactive protein in patients undergoing cardiac surgery . Anaesthesia 1986; 41: 11-15 .

26.

American College of Chest Physicians / Society of Critical Care Medicine Consensus Conference . Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis . Crit Care Med 1992; 20: 864-874 .