Heredia-Rodríguez María, Bustamante-Munguira Juan, Lorenzo Mario, Gómez-Sánchez Esther, Álvarez F Javier, Fierro Inmaculada, Conejo Esther, Tamayo Eduardo
BioCritic. Group for biomedical Research in Critical Care Medicine, Valladolid, Spain; Department of Anesthesiology and Surgical Critical Care, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
Department of Cardiovascular Surgery, Hospital Universitario de La Princesa, Madrid, Spain.
J Surg Res. 2017 May 15;212:187-194. doi: 10.1016/j.jss.2017.01.021. Epub 2017 Feb 1.
Sepsis is strongly associated with an increased risk of postoperative mortality, longer length of hospital stay, and elevated health care costs. Early clinical symptoms overlap with those of systemic inflammatory response syndrome, a response that commonly occurs after cardiac surgery with cardiopulmonary bypass. Since a combination of biomarkers has been demonstrated to improve the prediction of postoperative infection, the objective of the present study was to test whether the combination of C-reactive protein (CRP), white blood cells (WBC), and procalcitonin (PCT) is able to predict postoperative infection in a large cohort of cardiac surgery patients.
Case-control study involving 423 patients who underwent cardiac surgery with cardiopulmonary bypass. Patients were retrospectively classified into two groups based on whether they developed severe sepsis or septic shock during the postoperative period. Blood samples for biological measurements (PCT, CRP, and WBC) were drawn on the first day in the intensive care unit, then once daily in the morning until the 10th postoperative day.
CRP median values were similar in both groups. WBC and PCT median values were significantly higher in patients with infection than without during the first 10 postoperative days. With elevation cutoffs ≤3 times (OR: 4.058; 95% CI: 2.206-7.463; P = 0.001) and ≥4 times (OR: 10.274, 95% CI: 3.690-28.604; P < 0.001), the median value for PCT (1.7 ng/mL) and/or WBC (13,000 cells/mm) on the second postoperative day was significantly associated with the development of infection.
The goal of this study was to use a large cohort of cardiac surgery patients to ensure that the results were representative of this population. The combination of PCT and WBC levels over the first three postoperative days was able to predict postoperative infection within the 30 d following cardiac surgery.
脓毒症与术后死亡风险增加、住院时间延长及医疗费用升高密切相关。早期临床症状与全身炎症反应综合征的症状重叠，这种反应常见于体外循环心脏手术后。由于已证明生物标志物组合可改善术后感染的预测，本研究的目的是测试C反应蛋白（CRP）、白细胞（WBC）和降钙素原（PCT）的组合能否在一大群心脏手术患者中预测术后感染。
病例对照研究，涉及423例行体外循环心脏手术的患者。根据患者术后是否发生严重脓毒症或感染性休克，将其回顾性分为两组。在重症监护病房的第一天采集用于生物学测量（PCT、CRP和WBC）的血样，然后在术后第10天前每天早晨采集一次。
两组的CRP中位数相似。术后前10天，感染患者的WBC和PCT中位数显著高于未感染患者。以升高阈值≤3倍（比值比：4.058；95%置信区间：2.206 - 7.463；P = 0.001）和≥4倍（比值比：10.274，95%置信区间：3.690 - 28.604；P < 0.001）计算，术后第二天PCT（1.7 ng/mL）和/或WBC（13,000个细胞/mm）的中位数与感染的发生显著相关。
本研究的目的是使用一大群心脏手术患者以确保结果能代表该人群。术后前三天PCT和WBC水平的组合能够预测心脏手术后30天内的术后感染。
