Key Laboratory of Arrhythmias of the Ministry of Education of China, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China (mainland).
Department of Cardiothoracic Surgery, BenQ Hospital, Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland).
Med Sci Monit. 2019 Apr 26;25:3077-3089. doi: 10.12659/MSM.913704.
BACKGROUND The incidence of early postoperative pneumonia (EPOP) after off-pump coronary artery bypass grafting surgery (CABG) is relatively high, but its diagnosis by traditional methods remains difficult, which could be deleterious to the prognosis. Moreover, few data exist regarding procalcitonin (PCT) in early diagnosis of pneumonia after off-pump CABG. Thus, this study was performed to evaluate the value of PCT in diagnosing EPOP after off-pump CABG. MATERIAL AND METHODS A total of 402 consecutive patients undergoing off-pump CABG were retrospectively enrolled. Forty-four patients were diagnosed with EPOP and 112 patients were diagnosed with systemic inflammatory response syndrome (SIRS). Chest roentgenogram, serum PCT, white blood cells, neutral granulocyte ratio, and daily maximum body temperature were recorded. The ability of PCT to diagnose EPOP was evaluated by receiver operating characteristic (ROC) analyses in comparison with traditional methods. Clinical net benefits were estimated via decision curve analysis (DCA). RESULTS PCT presented satisfying accuracy in diagnosing EPOP with a cutoff value of 1.585 ng/mL (area under the curve [AUC] 0.808, 95% confidence interval [CI] 0.724-0.891, sensitivity 73%, specificity 86%). PCT performed better in diagnosing EPOP among SIRS patients (AUC 0.868, 95% CI 0.748-0.988, sensitivity 85%, specificity 89%). DCA showed valuable clinical net benefits of PCT in diagnosing EPOP after off-pump CABG regardless of threshold selected. CONCLUSIONS PCT could be a diagnostic marker for EPOP after off-pump CABG. The optimal cutoff value for diagnosing EPOP was 1.585 ng/mL. The application of PCT in diagnosing EPOP in SIRS patients was also satisfying with a cutoff value of 1.775 ng/mL.
非体外循环冠状动脉旁路移植术（CABG）后早期术后肺炎（EPOP）的发病率相对较高，但传统方法诊断仍较为困难，这可能对预后不利。此外，关于非体外循环 CABG 术后肺炎降钙素原（PCT）的早期诊断数据较少。因此，本研究旨在评估 PCT 在诊断非体外循环 CABG 后 EPOP 中的价值。
回顾性纳入 402 例连续接受非体外循环 CABG 的患者。44 例患者被诊断为 EPOP，112 例患者被诊断为全身炎症反应综合征（SIRS）。记录胸片、血清 PCT、白细胞、中性粒细胞比值和每日最高体温。通过接受者操作特征（ROC）分析与传统方法比较，评估 PCT 诊断 EPOP 的能力。通过决策曲线分析（DCA）评估临床净获益。
PCT 诊断 EPOP 的截断值为 1.585ng/mL（曲线下面积[AUC]0.808，95%置信区间[CI]0.724-0.891，敏感性 73%，特异性 86%），具有令人满意的准确性。PCT 在 SIRS 患者中诊断 EPOP 的效果更好（AUC 0.868，95%CI 0.748-0.988，敏感性 85%，特异性 89%）。DCA 显示无论选择何种阈值，PCT 在诊断非体外循环 CABG 后 EPOP 方面均具有有价值的临床净获益。
PCT 可能是非体外循环 CABG 后 EPOP 的诊断标志物。诊断 EPOP 的最佳截断值为 1.585ng/mL。PCT 用于诊断 SIRS 患者 EPOP 的截断值为 1.775ng/mL，效果也令人满意。
