Saito Junichi, Hashiba Eiji, Mikami Akio, Kudo Tomoyuki, Niwa Hidetomo, Hirota Kazuyoshi
Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Division of Intensive Care Unit, Hirosaki University Hospital, Hirosaki, Japan.
J Cardiothorac Vasc Anesth. 2017 Aug;31(4):1262-1267. doi: 10.1053/j.jvca.2017.02.007. Epub 2017 Feb 3.
The authors investigated the presepsin-concentration profile after cardiac surgery compared with those of procalcitonin (PCT) and C-reactive protein (CRP).
A single-center, prospective, observational clinical study.
Hirosaki University Hospital.
Patients who underwent cardiovascular surgery without preoperative infection and end-stage kidney disease requiring dialysis. The patients also were subdivided into 2 groups with respect to the use of cardiopulmonary bypass (CPB).
Presepsin, PCT, and CRP were measured 4 times: before the induction of anesthesia (baseline), postoperative day (POD) 0, POD 1, and POD 2. Data are expressed as median (25th, 75th interquartiles). A total of 33 patients were examined: 22 patients with CPB and 11 without CPB. For the entire patient series, the presepsin concentrations on POD 0 (220 [166-445] pg/mL), POD 1 (328 [210-581] pg/mL), and POD 2 (310 [202-368] pg/mL) were increased significantly (p < 0.05) compared with baseline (176 [123-275] pg/mL). The PCT and CRP concentrations on POD 1 (0.57 [0.27-1.29] ng/mL and 5.4 [3.1-8.8] mg/dL) and POD 2 (0.64 [0.33-1.43] ng/mL and 11.8 [4.4-17.0] mg/dL) also were increased significantly (p < 0.05) compared with baseline (0.04 [0.03-0.06] ng/mL and 0.07 [0.03-0.22] mg/dL). However, the median concentrations of presepsin up to POD 2 were less than the reported cut-off value (600 pg/mL) to detect infections, whereas those of PCT were above the reported cut-off value (0.5 ng/mL). The increases in presepsin and PCT concentrations were independent of the use of CPB.
Cardiovascular surgery significantly increased presepsin concentrations, earlier than PCT and CRP.
作者研究了心脏手术后前降钙素浓度变化情况，并与降钙素原（PCT）和C反应蛋白（CRP）进行比较。
单中心、前瞻性、观察性临床研究。
弘前大学医院。
接受心血管手术且术前无感染及无需透析的终末期肾病患者。根据是否使用体外循环（CPB）将患者分为两组。
在麻醉诱导前（基线）、术后第0天（POD 0）、POD 1和POD 2这4个时间点测量前降钙素、PCT和CRP。数据以中位数（第25、75四分位数间距）表示。共检查了33例患者：22例使用CPB，11例未使用CPB。对于整个患者系列，与基线水平（176 [123 - 275] pg/mL）相比，POD 0（220 [166 - 445] pg/mL）、POD 1（328 [210 - 581] pg/mL）和POD 2（310 [202 - 368] pg/mL）时的前降钙素浓度显著升高（p < 0.05）。POD 1（0.57 [0.27 - 1.29] ng/mL和5.4 [3.1 - 8.8] mg/dL）和POD 2（0.64 [0.33 - 1.43] ng/mL和11.8 [4.4 - 17.0] mg/dL）时的PCT和CRP浓度与基线水平（0.04 [0.03 - 0.06] ng/mL和0.07 [0.03 - 0.22] mg/dL）相比也显著升高（p < 0.05）。然而，直至POD 2时前降钙素的中位数浓度低于报道的检测感染的临界值（600 pg/mL），而PCT的中位数浓度高于报道的临界值（0.5 ng/mL）。前降钙素和PCT浓度的升高与是否使用CPB无关。
心血管手术显著提高了前降钙素浓度，且早于PCT和CRP。
