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

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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.

No MeSH data available.


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Mentions: During the study period, 1272 patients underwent cardiac surgery with extracorporeal circulation. Of these, 407 patients did not meet inclusion criteria due to urgent or emergency surgery or refused participation. In total, 114 patients were excluded due to severe postoperative complications occurring in the immediate postoperative course. The final study population thus included 751 patients with an initially uneventful postoperative course. Of these 117 patients developed delayed complications after discharge from the intensive care unit (Fig. 1). Patients developing delayed complications were generally: older, had poorer preoperative renal function, a higher EuroSCORE 2 and lower left-ventricular ejection fraction. Operation time and CBP time were longer, and the portion of combined surgery was higher in this group. The outcome worsened in patients developing delayed complications compared without. ICU readmission was observed in 51 of 117 patients developing delayed complications. They had a significantly increased mechanical ventilation time, prolonged length of stay in the intensive care unit and hospital, as well as a higher hospital mortality (Table 1). Fig. 1


Prognostic value of procalcitonin in patients after elective cardiac surgery: a prospective cohort study
Flowchart
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120170&req=5

Fig1: Flowchart
Mentions: During the study period, 1272 patients underwent cardiac surgery with extracorporeal circulation. Of these, 407 patients did not meet inclusion criteria due to urgent or emergency surgery or refused participation. In total, 114 patients were excluded due to severe postoperative complications occurring in the immediate postoperative course. The final study population thus included 751 patients with an initially uneventful postoperative course. Of these 117 patients developed delayed complications after discharge from the intensive care unit (Fig. 1). Patients developing delayed complications were generally: older, had poorer preoperative renal function, a higher EuroSCORE 2 and lower left-ventricular ejection fraction. Operation time and CBP time were longer, and the portion of combined surgery was higher in this group. The outcome worsened in patients developing delayed complications compared without. ICU readmission was observed in 51 of 117 patients developing delayed complications. They had a significantly increased mechanical ventilation time, prolonged length of stay in the intensive care unit and hospital, as well as a higher hospital mortality (Table 1). Fig. 1

View Article: PubMed Central - PubMed

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.

No MeSH data available.