Popov Dmitry, Plyushch Marina, Ovseenko Svetlana, Abramyan Marina, Podshchekoldina Olga, Yaroustovsky Mikhail
Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russian Federation.
Kardiochir Torakochirurgia Pol. 2015 Mar;12(1):30-6. doi: 10.5114/kitp.2015.50565. Epub 2015 Mar 31.
Prediction of complications and mortality after cardiac surgery is an important aspect of timely correction of these conditions. One possibility in this case is the use of biomarkers and some prognostic scores.
To study the prognostic value of presepsin (PSP) as a predictor of postoperative complications development in cardiosurgical patients.
Patients operated for acquired heart diseases with cardiopulmonary bypass (CPB) were included in the study (n = 51, age: 58 ± 11 years). Besides routine clinical and laboratory data, PSP and procalcitonin (PCT) levels were monitored perioperatively (before surgery, and on the 1(st), 2(nd), 3(rd) and 6(th) day after surgery).
There were no clinical signs of infection before surgery in any of the studied patients. We found supranormal PSP levels in 6 patients (11.8%) before operations (543 [519-602] pg/ml, max 1597 pg/ml; normal value: 365 pg/ml). Infectious complications developed in 19 patients (37%). Statistically significant differences in PSP levels, APACHE II (Acute Physiology and Chronic Health Evaluation II) and SOFA (Sequential Organ Failure Assessment) scores in groups of patients with and without infection were documented from the 1(st) and in PCT from the 2(nd) day after the operation. The cut-off values were 702 pg/ml, 8.5 points, 7.5 points and 3.3 ng/ml, respectively. Hospital mortality was 13.7% (7 patients); all cases of death were in the group of patients with infectious complications. Statistically significant differences in PCT levels, APACHE II and SOFA scores between the groups with favorable and lethal outcomes were observed from the first postoperative day. The same for PSP levels was documented only on the 3(rd) postoperative day. The cut-off values were 7.42 ng/ml, 11 points, 8.5 points and 683 pg/ml, respectively.
The use of modern biomarkers alongside integral severity-of-disease scores allows prediction of the risk of infectious complications and mortality in cardiosurgical patients.
心脏手术后并发症和死亡率的预测是及时纠正这些情况的重要方面。在这种情况下，一种可能性是使用生物标志物和一些预后评分。
研究前降钙素原（PSP）作为心脏手术患者术后并发症发生预测指标的预后价值。
纳入接受体外循环（CPB）治疗后天性心脏病的患者（n = 51，年龄：58±11岁）。除常规临床和实验室数据外，围手术期（手术前、术后第1、2、3和6天）监测PSP和降钙素原（PCT）水平。
所有研究患者术前均无感染临床症状。我们发现6例患者（11.8%）术前PSP水平超常（543 [519 - 602] pg/ml，最高1597 pg/ml；正常值：365 pg/ml）。19例患者（37%）发生感染性并发症。术后第1天起，有感染和无感染患者组的PSP水平、急性生理与慢性健康状况评分系统II（APACHE II）和序贯器官衰竭评估（SOFA）评分存在统计学显著差异，术后第2天起PCT存在统计学显著差异。截断值分别为702 pg/ml、8.5分、7.5分和3.3 ng/ml。医院死亡率为13.7%（7例患者）；所有死亡病例均在感染性并发症患者组。术后第1天起，预后良好和不良组的PCT水平、APACHE II和SOFA评分存在统计学显著差异。PSP水平仅在术后第3天出现相同情况。截断值分别为7.42 ng/ml、11分、8.5分和683 pg/ml。
将现代生物标志物与整体疾病严重程度评分相结合，可预测心脏手术患者感染性并发症和死亡风险。
