Baykut D, Schulte-Herbrüggen J, Krian A
Division of Cardiothoracic Surgery, University Clinics, Kantonsspital Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland.
Eur J Med Res. 2000 Dec 29;5(12):530-6.
BACKGROUND/OBJECTIVE: Cardiopulmonary bypass generally leads to an unspecific increase of inflammatory parameters after cardiac operations. Increased Procalcitonin (PCT)-levels in serum, particularly after contamination with bacterial endotoxines, can be used as a marker for specific infections. The objective of this prospective study was to evaluate the course of PCT after cardiac surgery for the differential diagnosis of infections/unspecific inflammatory reactions, compared to routine infection parameters.
Serum PCT levels were measured in 400 routine cardiosurgical patients preoperatively and at 1., 2., 4. and 6. postoperative days with a luminescence immunoassay. PCT-values were compared to the patient's clinical infection status, body temperature, leukocyte count and C-reactive protein (CRP).
364 patients had an infection-free postoperative course, 27 patients developed infections. All of these patients showed elevated infection parameters at 1-2. postoperative days. In patients without infection, these parameters decreased after 2. postoperative day. Patients predisposed to an infection had continuously high temperature, leukocytes, CRP and PCT until 4.postoperative day with leukocytes and CRP decreasing after 4.postoperative day. PCT however showed a divergent course with a second increase in these patients between 4.-6. postop day (p<0.001). At this time, no clinical sign of an infection was evident. The increase of PCT was independent of infection type, but most apparent in bacteriemia/sepsis.
Based on its different course from other parameters in infection development between 4.-6. days, PCT can probably be used as a predictive marker in bacterial infections after cardiac surgery. The cost of the used immunoassay however will set the limits for a routine application.
背景/目的：体外循环通常会导致心脏手术后炎症参数非特异性升高。血清降钙素原（PCT）水平升高，尤其是在受到细菌内毒素污染后，可作为特定感染的标志物。这项前瞻性研究的目的是评估心脏手术后PCT的变化过程，以便与常规感染参数相比，用于感染/非特异性炎症反应的鉴别诊断。
采用发光免疫分析法对400例常规心脏手术患者在术前及术后第1、2、4和6天测量血清PCT水平。将PCT值与患者的临床感染状况、体温、白细胞计数和C反应蛋白（CRP）进行比较。
364例患者术后无感染，27例发生感染。所有这些感染患者在术后1 - 2天感染参数均升高。未感染患者在术后第2天之后这些参数下降。易感染患者直到术后第4天体温、白细胞、CRP和PCT一直处于高水平，白细胞和CRP在术后第4天之后下降。然而，PCT呈现不同的变化过程，在这些患者中术后第4 - 6天出现第二次升高（p<0.001）。此时，没有明显的感染临床迹象。PCT的升高与感染类型无关，但在菌血症/脓毒症中最为明显。
基于其在术后4 - 6天感染发展过程中与其他参数不同的变化过程，PCT可能可以作为心脏手术后细菌感染的预测标志物。然而，所用免疫分析方法的成本将限制其常规应用。
