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

Klingele, Matthias; Bomberg, Hagen; Schuster, Simone; Schäfers, Hans‐Joachim; Groesdonk, Heinrich V.

doi:10.1186/s13613-016-0215-8

Cited by 31 publications

(27 citation statements)

References 31 publications

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“…In patients with stopping advice, this occurred only in 42.3% (11/26). These results are in line with previous studies which showed that high PCT levels are associated with an unfavourable outcome [ 27 , 28 ]. Furthermore, a not adequately declining PCT is an independent predictor of mortality in septic patients [ 29 , 30 ].…”

Section: Discussionsupporting

confidence: 93%

Adherence to a procalcitonin-guided antibiotic treatment protocol in patients with severe sepsis and septic shock

Höhn

Balfer

Heising

et al. 2018

Ann. Intensive Care

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BackgroundIn randomised controlled trials, procalcitonin (PCT)-guided antibiotic treatment has been proven to significantly reduce length of antibiotic therapy in intensive care unit (ICU) patients. However, concern was raised on low protocol adherence and high rates of overruling, and thus the value of PCT-guided treatment in real clinical life outside study conditions remains unclear. In this study, adherence to a PCT protocol to guide antibiotic treatment in patients with severe sepsis and septic shock was analysed.MethodsFrom 2012 to 2014, surgical ICU patients with severe sepsis or septic shock were retrospectively screened for PCT measurement series appropriate to make treatment decisions on antibiotic therapy. We compared (1) patients with appropriate PCT measurement series to patients without appropriate series; (2) patients who reached the antibiotic stopping advice threshold (PCT < 0.5 ng/mL and/or decrease to 10% of peak level) to patients who did not reach a stopping advice threshold; and (3) patients who were treated adherently to the PCT protocol to non-adherently treated patients. The groups were compared in terms of antibiotic treatment duration, PCT kinetics, and other clinical outcomes.ResultsOf 81 patients with severe sepsis or septic shock, 14 were excluded due to treatment restriction or short course in the ICU. The final analysis was performed on 67 patients. Forty-two patients (62.7%) had appropriate PCT measurement series. In patients with appropriate PCT series, median initial PCT (p = 0.001) and peak PCT levels (p < 0.001) were significantly higher compared to those with non-appropriate series. In 26 patients with appropriate series, PCT levels reached an antibiotic stopping advice. In 8 of 26 patients with stopping advice, antibiotics were discontinued adherently to the PCT protocol (30.8%). Patients with adherently discontinued antibiotics had a shorter antibiotic treatment (7d [IQR 6–9] vs. 12d [IQR 9–16]; p = 0.002). No differences were seen in terms of other clinical outcomes.ConclusionIn patients with severe sepsis and septic shock, procalcitonin testing was irregular and adherence to a local PCT protocol was low in real clinical life. However, adherently treated patients had a shorter duration of antibiotic treatment without negative clinical outcomes. Procalcitonin peak values and kinetics had a clear impact on the regularity of PCT testing.Electronic supplementary materialThe online version of this article (10.1186/s13613-018-0415-5) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 93%

Adherence to a procalcitonin-guided antibiotic treatment protocol in patients with severe sepsis and septic shock

Höhn

Balfer

Heising

et al. 2018

Ann. Intensive Care

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“…As acute phase reactions following CPB are associated with organ dysfunction, there is a continuing effort to identify a biomarker for use in early diagnosis of complications after cardiac surgery. It is known that PCT affects the clinical course after cardiac surgery 22 and is a more sensitive indicator than the increase in WBCs or CRP in predicting complications; moreover, the role of PCT is expanding to include prognostic use in specific acute cardiovascular diseases such as aortic dissection. 23 Elevated PCT levels have a negative impact on postoperative complications and outcomes.…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Procalcitonin for Infection and Survival in Adult Cardiogenic Shock Patients Treated with Extracorporeal Membrane Oxygenation

et al. 2018

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Procalcitonin (PCT) is a predictive marker for the occurrence of bacterial infection and the decision to terminate antibiotic treatment in critically ill patients. An unusual increase in PCT, regardless of infection, has been observed during extracorporeal membrane oxygenation (ECMO) support. We evaluated trends and the predictive value of PCT levels in adult cardiogenic shock during treatment with ECMO. We reviewed the clinical records of 38 adult cardiogenic shock patients undergoing veno-arterial ECMO support between January 2014 and December 2016. The exclusion criteria were age <18 years, pre-ECMO infection, and less than 48 hours of support. The mean patient age was 56.7±14.7 years and 12 (31.6%) patients were female. The mean duration of ECMO support was 9.0±7.6 days. The rates of successful ECMO weaning and survival to discharge were 55.3% (n=21) and 52.6% (n=20), respectively. There were 17 nosocomial infections in 16 (42.1%) patients. Peak PCT levels (mean 25.6±9.4 ng/mL) were reached within 48 hours after initiation of ECMO support and decreased to ≤5 ng/mL within one week. The change in PCT levels was not useful in predicting the occurrence of new nosocomial infections during the ECMO run. However, a PCT level >10 ng/mL during the first week of ECMO support was significantly associated with mortality (p<0.01). The change in PCT level was not useful in predicting new infection during ECMO support. However, higher PCT levels within the first week of the ECMO run are associated with significantly higher mortality.

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“…Clementi et al presented results that the PCT measurement performed 48 hours after the cardiac operation was a good predictor of postoperative renal and respiratory complications [14]. In another study, Klingele et al showed that a single PCT measurement taken the day after surgery was a predictor of delayed complications such as prolonged hospitalization, ICU readmission, and hospital death [26]. dysfunction, linking in ammation as an essential mechanism in the pathophysiology of delirium [27].…”

Section: Discussionmentioning

confidence: 99%

Elevated Procalcitonin and Depression As Risk Factors For Postoperative Delirium In The Elderly After Cardiac Surgery – A Prospective Observational Study.

Kupiec

Adamik

Kozera

et al. 2020

Preprint

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Background One of the most common complications after cardiac surgery is delirium. Determining the origin of this complication from possible pathomechanisms is difficult. The activation of an inflammatory response during surgery has been suggested as one possible mechanism of delirium. The usefulness of the inflammatory marker procalcitonin (PCT) as a predictor of delirium after cardiac surgery with cardiopulmonary bypass (CBP) has not yet been investigated. Methods The purpose of this study was to prospectively investigate the risk of developing postoperative delirium in a group of elderly patients using a multivariate assessment of preoperative (PCT, comorbidities, functional decline, depression) and intraoperative risk factors. 149 elderly patients were included. Delirium was assessed using the Confusion Assessment Method for the ICU. Results Thirty patients (20%) developed post-operative delirium: hypoactive in 50%, hyperactive in 33%, mixed in 17%. Preoperative PCT above the reference range (> 0.05 ng/mL) was recorded more often in patients who postoperatively developed delirium than in the non-delirium group (50% vs. 27%, p=0.019). After surgery, PCT was significantly higher in the delirium than the non-delirium group: ICU admission after surgery: 0.08 ng/mL, IQR 0.03-0.15 vs. 0.05 ng/mL, IQR 0.02-0.09, p=0.011), and for consecutive days (day 1: 0.59 ng/mL, IQR 0.25-1.55 vs. 0.25 ng/mL, IQR 0.14-0.54, p=0.003; day 2: 1.21 ng/mL, IQR 0.24-3.29 vs. 0.36 ng/mL, IQR 0.16-0.76, p=0.006; day 3: 0.76 ng/mL, IQR 0.48-2.34 vs. 0.34 ng/mL, IQR 0.14-0.66, p=0.001). Patients with delirium were older (74 years, IQR 70 – 76 vs. 69 years, IQR 67 – 74; p=0.038) and more often had functional decline (47% vs. 28%, p=0.041). There was no difference in comorbidities with the exception of anaemia (43% vs. 19%, p=0.006). Depression was detected in 40% of patients with delirium and in 17% without delirium (p=0.005). In a multivariable logistic regression model of preoperative procalcitonin (OR= 3.05; IQR 1.02-9.19), depression (OR=5.02, IQR 1.67-15.10), age (OR=1.14; IQR 1.02-1.26), functional decline (OR=0.76; IQR 0.63-0.91) along with CPB time (OR=1.04; IQR 1.02-1.06) were significant predictors of postoperative delirium. Conclusion A preoperative PCT test and assessment of functional decline and depression may help identify patients at risk for developing delirium after cardiac surgery.

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

Cited by 31 publications

References 31 publications

Adherence to a procalcitonin-guided antibiotic treatment protocol in patients with severe sepsis and septic shock

Adherence to a procalcitonin-guided antibiotic treatment protocol in patients with severe sepsis and septic shock

Predictive Value of Procalcitonin for Infection and Survival in Adult Cardiogenic Shock Patients Treated with Extracorporeal Membrane Oxygenation

Elevated Procalcitonin and Depression As Risk Factors For Postoperative Delirium In The Elderly After Cardiac Surgery – A Prospective Observational Study.

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