Prognostic value of procalcitonin in patients after elective cardiac surgery: a prospective cohort study

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

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 in-hospital 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.

Related collections

Most cited references 28

Record: found
Abstract: found
Article: not found

High serum procalcitonin concentrations in patients with sepsis and infection.

M Assicot, H Carsin, Gregory Raymond … (1993)

High concentrations of calcitonin-like immunoreactivity have been found in the blood of patients with various extrathyroid diseases. By means of a monoclonal immunoradiometric assay for calcitonin precursors, we have measured serum concentrations of procalcitonin in patients with various bacterial and viral infections. 79 children (newborn to age 12 years) in hospital with suspected infections were investigated prospectively. 19 patients with severe bacterial infections had very high serum concentrations of procalcitonin at diagnosis (range 6-53 ng/mL) in comparison with 21 children found to have no signs of infection (baseline concentrations < 0.1 ng/mL). Serum procalcitonin values decreased rapidly during antibiotic therapy. 11 patients with peripheral bacterial colonisation or local infections without invasive sepsis and 18 (86%) of 21 patients with viral infections had concentrations within or slightly above the normal range (0.1-1.5 ng/mL). Among 9 severely burned patients studied in an intensive care unit, the post-traumatic course of procalcitonin concentrations (range 0.1-120 ng/mL) was closely related to infectious complications and acute septic episodes. Concentrations of mature calcitonin were normal in all subjects, whatever procalcitonin concentrations were found. Concentrations of a substance immunologically identical to procalcitonin are raised during septic conditions. Serum concentrations seem to be correlated with the severity of microbial invasion.

0 comments Cited 165 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Postresuscitation disease after cardiac arrest: a sepsis-like syndrome?

Christian Spaulding, Ivan Laurent, Christophe Adrie … (2004)

Despite advances in cardiac arrest resuscitation, neurologic impairments and other organ dysfunctions cause considerable mortality and morbidity after restoration of spontaneous cardiac activity. The mechanisms underlying this postresuscitation disease probably involve a whole-body ischemia and reperfusion syndrome that triggers a systemic inflammatory response. Postresuscitation disease is characterized by high levels of circulating cytokines and adhesion molecules, the presence of plasma endotoxin, and dysregulated leukocyte production of cytokines: a profile similar to that seen in severe sepsis. Transient myocardial dysfunction can occur after resuscitation, mainly as a result of myocardial stunning. However, early successful angioplasty is independently associated with better outcomes after cardiac arrest associated with myocardial infarction. Coagulation abnormalities occur consistently after successful resuscitation, and their severity is associated with mortality. For example, plasma protein C and S activities after successful resuscitation are lower in nonsurvivors than in survivors. Low baseline cortisol levels may be associated with an increased risk of fatal early refractory shock after cardiac arrest, suggesting adrenal dysfunction in these patients. Postresuscitation abnormalities after cardiac arrest mimic the immunologic and coagulation disorders observed in severe sepsis. This suggests that therapeutic approaches used recently with success in severe sepsis should be investigated in patients successfully resuscitated after cardiac arrest.

0 comments Cited 101 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Procalcitonin increase in early identification of critically ill patients at high risk of mortality.

Jens-Ulrik Jensen, Lars Heslet, Kurt Espersen … (2006)

To investigate day-by-day changes in procalcitonin and maximum obtained levels as predictors of mortality in critically ill patients. Prospective observational cohort study. : Multidisciplinary intensive care unit at Rigshospitalet, Copenhagen University Hospital, a tertiary reference hospital in Denmark. Four hundred seventy-two patients with diverse comorbidity and age admitted to this intensive care unit. Equal in all patient groups: antimicrobial treatment adjusted according to the procalcitonin level. Daily procalcitonin measurements were carried out during the study period as well as measurements of white blood cell count and C-reactive protein and registration of comorbidity. The primary end point was all-cause mortality in a 90-day follow-up period. Secondary end points were mortality during the stay in the intensive care unit and in a 30-day follow-up period. A total of 3,642 procalcitonin measurements were evaluated in 472 critically ill patients. We found that a high maximum procalcitonin level and a procalcitonin increase for 1 day were independent predictors of 90-day all-cause mortality in the multivariate Cox regression analysis model. C-reactive protein and leukocyte increases did not show these qualities. The adjusted hazard ratio for procalcitonin increase for 1 day was 1.8 (95% confidence interval 1.3-2.7). The relative risk for mortality in the intensive care unit for patients with an increasing procalcitonin was as follows: after 1 day increase, 1.8 (95% confidence interval 1.4-2.4); after 2 days increase, 2.2 (95% confidence interval 1.6-3.0); and after 3 days increase: 2.8 (95% confidence interval 2.0-3.8). A high maximum procalcitonin level and a procalcitonin increase for 1 day are early independent predictors of all-cause mortality in a 90-day follow-up period after intensive care unit admission. Mortality risk increases for every day that procalcitonin increases. Levels or increases of C-reactive protein and white blood cell count do not seem to predict mortality.

0 comments Cited 87 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Matthias Klingele: klingelemat@yahoo.fr

Hagen Bomberg: Hagen.bomberg@uks.eu

Simone Schuster: simone_schuster79@web.de

Hans-Joachim Schäfers: h-j.schaefers@uks.eu

Heinrich Volker Groesdonk: +49 6841 16 22485 , heinrich.groesdonk@uks.eu

Journal

Journal ID (nlm-ta): Ann Intensive Care

Journal ID (iso-abbrev): Ann Intensive Care

Title: Annals of Intensive Care

Publisher: Springer Paris (Paris )

ISSN (Electronic): 2110-5820

Publication date (Electronic): 23 November 2016

Publication date PMC-release: 23 November 2016

Publication date Collection: 2016

Volume: 6

Electronic Location Identifier: 116

Affiliations

[1 ]Division of Nephrology and Hypertension, Department of Medicine, Saarland University Medical Center, University of Saarland, Homburg/Saar, Germany

[2 ]Department of Medicine, Hochtaunuskliniken, Usingen, Germany

[3 ]Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, University of Saarland, Kirrbergerstrasse, 66421 Homburg/Saar, Germany

[4 ]Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, University of Saarland, Homburg/Saar, Germany

Article

Publisher ID: 215

DOI: 10.1186/s13613-016-0215-8

PMC ID: 5120170

PubMed ID: 27878573

SO-VID: 2ee30c17-3889-4200-941d-d763bf517e9c

License:

Open AccessThis 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.