Early Predictive Value of Procalcitonin for the Diagnosis of Pulmonary Infections after Off-pump Coronary Artery Bypass Grafting
DOI:
https://doi.org/10.1532/hsf.3381Keywords:
Procalcitonin; Off-pump coronary artery bypass grafting; Pulmonary infection; White blood cell; High-sensitivity C-reactive protein; Perioperative myocardial infarction.Abstract
Background: Cardiac surgery can cause similar inflammatory reactions with infection; antibacterial treatment may be inappropriately used. Early and accurate diagnosis of infection still is a difficult problem worldwide. Procalcitonin (PCT) helps to identify sepsis caused by bacterial infections. However, its application in the diagnosis of pulmonary infections after off-pump coronary artery bypass grafting (OPCABG) has not been well studied. We investigated the early predictive value of PCT for the diagnosis of pulmonary infections after OPCABG.
Methods: We retrospectively analyzed the clinical data, including conditions in the intensive care unit, postoperative complications, mortality rate, plasma PCT in the morning on the first postoperative day, routine white blood cell (WBC) count, and high-sensitivity C-reactive protein (hs-CRP) levels of patients who underwent elective OPCABG. Patients were divided into an infection group and a noninfection group, according to the occurrence of pulmonary infections. A receiver operating characteristic (ROC) curve was used to analyze the predictive value of PCT for the diagnosis of postsurgical infections.
Results: In total, 131 patients who underwent OPCABG were included, of whom 23 (17.6%) developed pulmonary infections. The plasma PCT level significantly was higher in the infection group than in the noninfection group (6.0 ± 6.3 ng/ml vs. 2.0 ± 2.2 ng/ml, P = 0.007). WBC and hs-CRP values were not significantly different between the infection group and the noninfection group (12.3 ± 3.9×109/L vs. 11.1 ± 2.8×109/L, P = 0.171 and 12.4 ± 0.7 mg/L vs. 12.4 ± 0.8 mg/L, P = 0.903, respectively). The area under the ROC for predicting pulmonary infections after OPCABG by plasma PCT was 0.783 (P < 0.001, with a 95% confidence interval of 0.674–0.893), with a cut-off value of 3.55 ng/ml, a sensitivity of 0.609, and a specificity of 0.861.
Conclusion: From our study results, we postulate that PCT has a high early predictive value for the diagnosis of pulmonary infections after OPCABG.
References
Aouifi A, Piriou V, Bastien O, Blanc P, Bouvier H, Evans R, Celard M, Vandenesch F, Rousson R, Lehot JJ. 2000. Usefulness of procalcitonin for diagnosis of infection in cardiac surgical patients. Crit Care Med. 28(9):3171-3176.
Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. 1993. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 341(8844):515-518.
Bartoletti M, Antonelli M, Bruno Blasi FA, Casagranda I, Chieregato A, Fumagalli R, Girardis M, Pieralli F, Plebani M, Rossolini GM, et al. 2018. Procalcitonin-guided antibiotic therapy: An expert consensus. Clin Chem Lab Med 56(8):1223-1229.
Dandona P, Nix D, Wilson MF, Aljada A, Love J, Assicot M, Bohuon C. 1994. Procalcitonin increase after endotoxin injection in normal subjects. J Clin Endocrinol Metab. 79(6):1605-1608.
Dorge H, Schondube FA, Dorge P, Seipelt R, Voss M, Messmer BJ. 2003. Procalcitonin is a valuable prognostic marker in cardiac surgery but not specific for infection. Thorac Cardiovasc Surg. 51(6):322-326.
Ferrer R, Martin-Loeches I, Phillips G, Osborn TM, Townsend S, Dellinger RP, Artigas A, Schorr C, Levy MM. 2014. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: Results from a guideline-based performance improvement program. Crit Care Med. 42(8):1749-1755.
Gaieski DF, Mikkelsen ME, Band RA, Pines JM, Massone R, Furia FF, Shofer FS, Goyal M. 2010. Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department. Crit Care Med. 38(4):1045-1053.
Horan TC, Andrus M, Dudeck MA. 2008. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 36(5):309-332.
Huttner A, Harbarth S, Carlet J, Cosgrove S, Goossens H, Holmes A, Jarlier V, Voss A, Pittet D. 2013. Antimicrobial resistance: A global view from the 2013 World Healthcare-Associated Infections Forum. Antimicrob Resist Infect Control. 2:31.
Kallel S, Abid M, Jarraya A, Abdenadher M, Mnif E, Frikha I, Ayadi F, Karoui A. 2012. Kinetics, diagnostic and prognostic value of procalcitonin after cardiac surgery. Ann Biol Clin. 70(5):567-580.
Muller B, White JC, Nylen ES, Snider RH, Becker KL, Habener JF. 2001. Ubiquitous expression of the calcitonin-i gene in multiple tissues in response to sepsis. J Clin Endocrinol Metab. 86(1):396-404.
Prkno A, Wacker C, Brunkhorst FM, Schlattmann P. 2013. Procalcitonin-guided therapy in intensive care unit patients with severe sepsis and septic shock: A systematic review and meta-analysis. Crit Care. 17(6):R291.
Uzzan B, Cohen R, Nicolas P, Cucherat M, Perret GY. 2006. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: A systematic review and meta-analysis. Crit Care Med. 34(7):1996-2003.
Ventola CL. 2015. The antibiotic resistance crisis: Part 1: Causes and threats. P T. 40(4):277-283.
Wacker C, Prkno A, Brunkhorst FM, Schlattmann P. 2013. Procalcitonin as a diagnostic marker for sepsis: A systematic review and meta-analysis. Lancet Infect Dis. 13(5):426-435.
Wang H, Cui N, Niu F, Xu H, Long Y, Liu D. 2017. Usefulness of procalcitonin for the diagnosis of infection in cardiac surgical patients. 29(10):897-901.
Wynne R, Botti M. 2004. Postoperative pulmonary dysfunction in adults after cardiac surgery with cardiopulmonary bypass: Clinical significance and implications for practice. Am J Crit Care. 13(5):384-393.
Zhao L, Zang X, Chen W, Sheng B, Gu X, Zhang J. 2015. Analysis of correlation between inflammatory parameters and severity of sepsis caused by bacterial bloodstream infection in septic patients. 27(6):448-453.
