Amin D N, Pruitt J C, Schuetz P
Cardiac Surgery Intensive Unit, Morton Plant Hospital, Clearwater, Florida, United States of America.
Anaesth Intensive Care. 2012 Sep;40(5):760-6. doi: 10.1177/0310057X1204000502.
Procalcitonin is a marker of significant bacterial infection. With Food and Drug Administration approval of a new high-sensitive procalcitonin assay in the United States, we felt it would be important to assess its normal elevation and time characteristics, as compared to other inflammatory markers in patients undergoing routine cardiac surgery. This is a prospective observational study including consecutive patients after routine cardiac surgery. Blood was sampled preoperatively, immediately postoperatively and daily until discharge or to postoperative day five for measurement of blood markers of infection. Patients were classified into different groups based on the type of surgery (on-pump and off-pump) and progression of recovery (complicated and uncomplicated). Patients after coronary artery bypass grafting off-pump (n=61) had significantly lower mean (0.90 vs 1.13 µg/l, P=0.006) and peak (2.09 vs 2.35 µg/l, P=0.002) procalcitonin levels in the postoperative course compared to patients with either on-pump valve surgery alone, on-pump coronary artery bypass grafting alone (n=28) or valve surgery with coronary artery bypass grafting (n=16). In addition, mean and peak procalcitonin levels were significantly higher (P=0.004 and P=0.002 respectively) in the 60 patients with a complicated course. This study provides insights into 'normal' kinetics of a new high-sensitive procalcitonin assay after different types of cardiac surgery, and in patients with and without a complicated postoperative course. Our results suggest that using a single procalcitonin level to guide antibiotic therapy decisions during the early period after major cardiac surgery may not be useful and that monitoring its kinetic may be the preferred strategy.
降钙素原是严重细菌感染的一个标志物。随着美国食品药品监督管理局批准了一种新的高敏降钙素原检测方法，我们认为，与接受常规心脏手术患者的其他炎症标志物相比，评估其正常升高情况及时间特征很重要。这是一项前瞻性观察性研究，纳入了接受常规心脏手术的连续患者。术前、术后即刻以及术后每日直至出院或术后第5天采集血样，以检测感染的血液标志物。根据手术类型（体外循环和非体外循环）及恢复进程（复杂和非复杂）将患者分为不同组。与仅接受体外循环瓣膜手术、仅接受体外循环冠状动脉旁路移植术（n = 28）或瓣膜手术联合冠状动脉旁路移植术（n = 16）的患者相比，非体外循环冠状动脉旁路移植术患者（n = 61）术后降钙素原的平均水平（0.90 vs 1.13 µg/l，P = 0.006）和峰值水平（2.09 vs 2.35 µg/l，P = 0.002）显著更低。此外，60例恢复进程复杂的患者降钙素原的平均水平和峰值水平显著更高（分别为P = 0.004和P = 0.002）。本研究深入探讨了不同类型心脏手术后新型高敏降钙素原检测方法的“正常”动力学情况，以及术后恢复进程复杂和不复杂患者的情况。我们的结果表明，在心脏大手术后早期使用单一降钙素原水平指导抗生素治疗决策可能并无用处，监测其动力学变化可能是更可取的策略。
