Effect of cardiopulmonary bypass on serum procalcitonin and C-reactive protein concentrations

Abstract

We have measured serum procalcitonin (PCT) concentrations after cardiac surgery in 36 patients allocated to one of three groups: group 1, coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) (n = 12); group 2, CABG without CPB (n = 12); and group 3, valvular surgery with CPB (n = 12). Serum PCT and C-reactive protein (CRP) concentrations were measured before operation, at the end of surgery and daily until postoperative day 8. Serum PCT concentrations increased, irrespective of the type of cardiac surgery, with maximum concentrations on day 1: mean 1.3 (SD 1.8), 1.1 (1.2) and 1.4 (1.2) ng ml-1 in groups 1, 2 and 3, respectively (ns). Serum PCT concentrations remained less than 5 ng ml-1 in all patients. Concentrations returned to normal by day 5 in all groups. To determine the effect of the systemic inflammatory response (SIRS) on serum PCT concentrations, patients were divided post hoc, without considering the type of cardiac surgery, into patients with SIRS (n = 19) and those without SIRS (n = 17). The increase in serum PCT was significantly greater in SIRS (peak PCT 1.79 (1.64) ng ml-1 vs 0.34 (0.32) ng ml-1 in patients without SIRS) (P = 0.005). Samples for PCT and CRP measurements were obtained from 10 other patients with postoperative complications (circulatory failure n = 7; active endocarditis n = 2; septic shock n = 1). In these patients, serum PCT concentrations ranged from 6.2 to 230 ng ml-1. Serum CRP concentrations increased in all patients, with no differences between groups. The postoperative increase in CRP lasted longer than that of PCT. We conclude that SIRS induced by cardiac surgery, with and without CPB, influenced serum PCT concentrations with a moderate and transient postoperative peak on the first day after operation. A postoperative serum PCT concentration of more than 5 ng ml-1 is highly suggestive of a postoperative complication.

Procalcitonin Kinetics and Nosocomial Pneumonia in Older Patients

“…17 Differences in the case mix (a higher proportion of surgical subjects were included) and critical severity (a higher proportion of septic shock and higher Sequential Organ Failure Assessment scores) may contribute to higher procalcitonin concentrations. [30][31][32] Second, procalcitonin kinetics within the first 72 h was also found to be significantly different because a decrease of Ն 26.2% was expected in the improved subjects and was regarded as an independent predictor of clinical efficacy. As a result, patient management might be reassessed if procalcitonin levels fall slowly (such as Ͻ 26.2% between days 0 and 3).…”

Lipopolysaccharide-Binding Protein: A New Biomarker for Infectious Endocarditis?

“…The inflammatory response caused by cardiac surgery is due to several stimuli, including exposure of the blood to nonphysiological surfaces, surgical trauma, and endotoxin release (29 ). CRP is strongly affected by surgical intervention within the first 24 h, independently of any existing bacteremia.…”

Plasminogen Activator Inhibitor-1 as a Predictor of Postoperative Atrial Fibrillation After Cardiopulmonary Bypass

“…2 A growing body of evidence suggests that inflammation and fibrosis contribute to the pathogenesis of AF. [3][4][5] The postoperative period is marked by a systemic inflammatory response characterized by increased concentrations of inflammatory and fibrinolytic markers including interleukin (IL)-6, 6,7 C-reactive protein (CRP), 8 and plasminogen activator inhibitor-1 (PAI-1). 9 The risk of developing postoperative AF in both on-pump and off-pump surgery is significantly higher in patients with high baseline CRP levels (Ͼ3.0 g/mL).…”