Department of Cardiac Surgery, University Hospital Jean Minjoz, and EA3920, University of Burgundy Franche-Comté, Besançon, France.
Department of Automated Biological Diagnosis, Hôpitaux Universitaires Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France.
Ann Thorac Surg. 2018 Feb;105(2):535-541. doi: 10.1016/j.athoracsur.2017.07.031. Epub 2017 Nov 11.
Postoperative pneumonia is frequent after cardiac surgery and is associated with increased morbidity and mortality. We tested the hypothesis that endocan is an early biomarker for the detection of pneumonia after cardiac surgery.
Between January and May 2016, 155 patients scheduled to undergo elective cardiac surgery with cardiopulmonary bypass were prospectively included in the study. Serum level of endocan was measured at five timepoints (preoperative, and at 6, 24, 48, and 72 hours after the end of surgery). Procalcitonin and C-reactive protein were measured at 24 and 72 hours. The preoperative and postoperative characteristics of the patients were recorded. Independent predictors of postoperative pneumonia were identified by logistic regression. Threshold values of endocan predictive of postoperative pneumonia were determined using receiver-operating characteristics curve analysis.
Seventeen patients (11%) had pneumonia after surgery. Endocan greater than 3.7 ng/mL before induction of anesthesia, or greater than 12.1 ng/mL at 6 hours after surgery, as well body mass index higher than 27 kg/m and duration of surgery were independent predictors of postoperative pneumonia. At induction of anesthesia, an endocan cutoff value of 3.7 ng/mL had 65% sensitivity and 72% specificity for the prediction of postoperative pneumonia; whereas at 6 hours, with a cutoff value of 12.1 ng/mL, these values were 71% and 75%, respectively. The time saved by endocan dosage compared with clinical diagnosis of postoperative pneumonia was 96 hours.
This study shows that endocan is an early marker of postoperative pneumonia in patients after cardiac surgery.
心脏手术后常发生术后肺炎，与发病率和死亡率增加有关。我们检验了内脂素是心脏手术后肺炎早期检测的生物标志物这一假说。
2016 年 1 月至 5 月，前瞻性纳入 155 例行体外循环心脏手术的择期心脏手术患者。分别在术前和术后 6、24、48 和 72 小时测量内脂素血清水平。在术后 24 和 72 小时测量降钙素原和 C 反应蛋白。记录患者术前和术后特征。采用逻辑回归确定术后肺炎的独立预测因子。使用受试者工作特征曲线分析确定预测术后肺炎的内脂素截断值。
术后 17 例（11%）患者发生肺炎。麻醉诱导前内脂素大于 3.7ng/mL，或术后 6 小时内脂素大于 12.1ng/mL，体重指数大于 27kg/m 和手术时间是术后肺炎的独立预测因子。麻醉诱导时，内脂素截断值为 3.7ng/mL 对术后肺炎的预测具有 65%的敏感性和 72%的特异性；而在术后 6 小时，截断值为 12.1ng/mL 时，这些值分别为 71%和 75%。与术后肺炎的临床诊断相比，内脂素检测可节省 96 小时的时间。
本研究表明，内脂素是心脏手术后患者术后肺炎的早期标志物。
