Wang Hao, Cui Na, Niu Fang, Xu Hongying, Long Yun, Liu Dawei
Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China (Wang H, Cui N, Long Y, Liu DW); Department of Critical Care Medicine, Affiliated Hospital of Jining Medical University, Jining 272000, Shandong, China (Niu F, Xu HY). Corresponding author: Liu Dawei, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017 Oct;29(10):897-901. doi: 10.3760/cma.j.issn.2095-4352.2017.10.007.
To determine the value of procalcitonin (PCT) as an early marker of postoperative infection after cardiac surgery with cardiopulmonary bypass (CPB).
A retrospective study was conducted. Patients with systemic inflammatory response syndrome (SIRS) after cardiac surgery with CPB admitted to intensive care unit (ICU) of Peking Union Medical College Hospital from November 2014 to January 2017 were enrolled. The cardiac surgery types and intraoperative conditions, the treatments in ICU, postoperative 28-day mortality and hospital mortality of the patients; the levels of plasma PCT measured at ICU admission, postoperative 1, 3, and 5 days were collected. According to whether patients with postoperative infection or not, they were divided into infection group and non-infection group. Receiver operating characteristic curve (ROC) was used to analyze the predictive value of plasma PCT levels at different time points in patients with infection.
Eighty-two patients were included in this study, 25 (30.5%) had microbiological evidence of pneumonia. The levels of plasma PCT were increased with a peak 1 day after cardiac surgery in all patients, then significantly decreased 5 days after operation. Compared with patients without infection, the levels of plasma PCT were significantly increased in patients with infection at immediate and 1, 3, 5 days post operation in ICU [μg/L: 10.0 (6.0, 64.5) vs. 5.0 (1.0, 10.0), 31.0 (10.0, 116.2) vs. 5.0 (1.0, 10.0), 34.7 (10.0, 60.4) vs. 2.9 (0.7, 9.3), 15.8 (7.7, 29.4) vs. 0.7 (0.5, 2.6), all P < 0.01]. The area under the ROC curve (AUC) of the plasma PCT levels at ICU admission, and 1, 3, 5 days thereafter to predict infection for critically ill patients with SIRS after CPB was 0.77, 0.82, 0.86, and 0.91, respectively (all P < 0.01), cut-off values were 6.8, 9.4, 9.2 and 3.9 μg/L, with the sensitivities of 76.0%, 84.0%, 79.2%, and 88.0%, and the specificities of 66.7%, 68.4%, 75.4%, and 78.9%, respectively.
In the presence of SIRS, elevated plasma PCT levels correlated with evidence of infection in early stage post operation in the ICU patients after cardiac surgery with use of CPB. The level of plasma PCT exceeded the cut-off value in different time points, suggesting infection, and it is helpful to predict the occurrence of infection early after operation.
确定降钙素原（PCT）作为体外循环（CPB）心脏手术后感染早期标志物的价值。
进行一项回顾性研究。纳入2014年11月至2017年1月在北京协和医院重症监护病房（ICU）接受CPB心脏手术并出现全身炎症反应综合征（SIRS）的患者。收集患者的心脏手术类型和术中情况、在ICU的治疗、术后28天死亡率和医院死亡率；以及在ICU入院时、术后1、3和5天测得的血浆PCT水平。根据患者术后是否发生感染，将其分为感染组和非感染组。采用受试者工作特征曲线（ROC）分析不同时间点血浆PCT水平对感染患者的预测价值。
本研究共纳入82例患者，其中25例（30.5%）有肺炎的微生物学证据。所有患者血浆PCT水平在心脏手术后1天升高至峰值，然后在术后5天显著下降。与未感染患者相比，感染患者在ICU术后即刻、1、3、5天的血浆PCT水平显著升高[μg/L：10.0（6.0，64.5）vs. 5.0（1.0，10.0），31.0（10.0，116.2）vs. 5.0（1.0，10.0），34.7（10.0，60.4）vs. 2.9（0.7，9.3），15.8（7.7，29.4）vs. 0.7（0.5，2.6），所有P<0.01]。CPB后发生SIRS的重症患者，ICU入院时及此后1、3、5天血浆PCT水平预测感染的ROC曲线下面积（AUC）分别为0.77、0.82、0.86和0.91（所有P<0.01），截断值分别为6.8、9.4、9.2和3.9μg/L，敏感性分别为76.0%、84.0%、79.2%和88.0%，特异性分别为66.7%、68.4%、75.4%和78.9%。
在存在SIRS的情况下，CPB心脏手术后ICU患者血浆PCT水平升高与术后早期感染证据相关。血浆PCT水平在不同时间点超过截断值提示感染，有助于早期预测术后感染的发生。
